Outcomes of Fontan conversion for failing Fontan circulation: mid-term results

Park, Han Ki; Shin, Hong Ju; Park, Young Hwan

doi:10.1093/icvts/ivw062

Cited by 13 publications

(5 citation statements)

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“…Our results revealed that conversion of a failing Fontan connection to a TCPC could be accomplished safely and successfully. Park [ 27 ] presented similar results recently.…”

Section: Discussionsupporting

confidence: 64%

30-year experience of Fontan surgery: single-centre’s data

Bezuska

Lebetkevičius

Lankutis

et al. 2017

J Cardiothorac Surg

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BackgroundThe Fontan procedure has been modified several times since it was introduced into practice in 1968. As many patients now survive to adulthood, attention is directed towards their clinical status and late morbidity. We report our surgical experience of 30 years in Fontan procedures.MethodsFrom January 1985 to January 2015, 80 patients underwent Fontan surgery. Twenty-one patients received an atrio-pulmonary Fontan (Group I), four patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), six patients received extra-cardiac TCPC with an aortic homograft (group III) and 49 patients received extra-cardiac TCPC with an expanded polytetrafluoroethylene conduit. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations.ResultsThe mean follow-up time was 7.4 ± 6.6 years. The Kaplan–Meier estimated 15-year survival rate was 42% in Group I, 50% in Group II, 83% in Group III and 94% in Group IV. The median length of stay in intensive care unit, intubation and chest drain stay time were 90 h (IQR, 46–119), 8 h (IQR, 6–16) and 18 days (IQR, 12–28) respectively. Early complications were bleeding (6), taken down of Fontan circulation (3) and acute heart failure managed by left heart bypass (1). Late-occurring morbidities included arrhythmias (6), protein-losing enteropathy (2), thromboembolism (2) and tracheal stenosis (1). Fourteen patients (18%) had redo Fontan procedures.ConclusionOur series showed improving results after Fontan completion with excellent mid-term outcome after extra-cardiac TCPC with expanded polytetrafluoroethylene conduit. The long-term result should be followed.

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“…Our results revealed that conversion of a failing Fontan connection to a TCPC could be accomplished safely and successfully. Park [ 27 ] presented similar results recently.…”

Section: Discussionsupporting

confidence: 64%

30-year experience of Fontan surgery: single-centre’s data

Bezuska

Lebetkevičius

Lankutis

et al. 2017

J Cardiothorac Surg

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“…Regarding the timing of reoperation, previous studies reported that the earlier indication for TCPC conversion was associated with better transplantation-free survival in Australia and New Zealand [ 9 ], and older age at the time of operation, AV valve regurgitation and the presence of PLE were poor prognostic factors for TCPC conversion [ 10 , 11 ]. Our study also showed that patients with a history of Fontan failure or end-organ dysfunction and a high CVP level had worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of reoperation after Fontan completion

Nakayama

Shinkawa

Hoki

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Patients who have achieved Fontan circulation may require reoperation. We reviewed the outcomes of reoperation after Fontan completion and assessed the risk factors for poor outcomes. METHODS This was a retrospective study of 106 patients undergoing open-heart reoperations after Fontan completion in 2003 at a single institution. RESULTS The mean age at reoperation was 24.6 ± 8.3 years. A history of Fontan failure or end-organ dysfunction was noted in 30 patients. The reoperations included 73 total cavopulmonary connection conversions, 29 atrioventricular or semilunar valve operations (17 with total cavopulmonary connection conversions) and 4 other operations. Eight early deaths occurred. During a median follow-up of 5.5 (0.01–16.2) years, there were 3 late deaths and 9 second cardiac operations. The 10-year survival rate after reoperation was 89.8%, and the 5-year second cardiac operation-free survival was 84.3%. The 10-year survival rates were significantly lower in patients who underwent surgery before 2011 (75.8% vs 100%), had a history of Fontan failure or end-organ dysfunction (71.7% vs 97.3%), had preoperative central venous pressure >15 mmHg (64.9% vs 96.5%) and were operated on with deep hypothermic circulatory arrest (DHCA) (60.0% vs 91.3%). A history of Fontan failure or end-organ dysfunction, preoperative central venous pressure >15 mmHg and requirement of DHCA were identified as risk factors for mortality. CONCLUSIONS Reoperation after Fontan completion resulted in excellent mid-term outcomes. A history of failed Fontan circulation and the requirement of DHCA negatively affected survival outcomes.

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“…Notable complications following the multi-stage surgical approach are arrhythmias, enlarged right atrium (RA), prolonged pleural drainage, seizure, and protein-losing enteropathy (PLE) ( Petko et al, 2003 ). While surgical revision of the Fontan pathway can be performed with low morbidity and mortality, minimally invasive therapeutic options in HLHS and/or HLHS-variants patients can be used to treat patients in frail condition ( Park et al, 2016 ). Patient surveillance typically involves regular pediatric cardiology evaluations with echocardiograms and electrocardiograms.…”

Section: Introductionmentioning

confidence: 99%

Interventional Planning for Endovascular Revision of a Lateral Tunnel Fontan: A Patient-Specific Computational Analysis

et al. 2021

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IntroductionA 2-year-old female with hypoplastic left heart syndrome (HLHS)-variant, a complex congenital heart defect (CHD) characterized by the underdevelopment of the left ventricle, presented with complications following single ventricle palliation. Diagnostic work-up revealed elevated Fontan pathway pressures, as well as significant dilation of the inferior Fontan pathway with inefficient swirling flow and hepatic venous reflux. Due to the frail condition of the patient, the clinical team considered an endovascular revision of the Fontan pathway. In this work, we performed a computational fluid dynamics (CFD) analysis informed by data on anatomy, flow, and pressure to investigate the hemodynamic effect of the endovascular Fontan revision.MethodsA patient-specific anatomical model of the Fontan pathway was constructed from magnetic resonance imaging (MRI) data using the cardiovascular modeling software CardiovasculaR Integrated Modeling and SimulatiON (CRIMSON). We first created and calibrated a pre-intervention 3D-0D multi-scale model of the patient’s circulation using fluid-structure interaction (FSI) analyses and custom lumped parameter models (LPMs), including the Fontan pathway, the single ventricle, arterial and venous systemic, and pulmonary circulations. Model parameters were iteratively tuned until simulation results matched clinical data on flow and pressure. Following calibration of the pre-intervention model, a custom bifurcated endograft was introduced into the anatomical model to virtually assess post-intervention hemodynamics.ResultsThe pre-intervention model successfully reproduced the clinical hemodynamic data on regional flow splits, pressures, and hepatic venous reflux. The proposed endovascular repair model revealed increases of mean and pulse pressure at the inferior vena cava (IVC) of 6 and 29%, respectively. Inflows at the superior vena cava (SVC) and IVC were each reduced by 5%, whereas outflows at the left pulmonary artery (LPA) and right pulmonary artery (RPA) increased by 4%. Hepatic venous reflux increased by 6%.ConclusionOur computational analysis indicated that the proposed endovascular revision would lead to unfavorable hemodynamic conditions. For these reasons, the clinical team decided to forgo the proposed endovascular repair and to reassess the management of this patient. This study confirms the relevance of CFD modeling as a beneficial tool in surgical planning for single ventricle CHD patients.

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Outcomes of Fontan conversion for failing Fontan circulation: mid-term results

Abstract: Fontan conversion to TCPC in patients with failing Fontan circulation can be performed with low risk of morbidity and mortality. The procedure confers better quality of life and is functional for patients with failed Fontan circulation.

Cited by 13 publications

References 10 publications

30-year experience of Fontan surgery: single-centre’s data

30-year experience of Fontan surgery: single-centre’s data

Surgical outcomes of reoperation after Fontan completion

Interventional Planning for Endovascular Revision of a Lateral Tunnel Fontan: A Patient-Specific Computational Analysis

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