Surgical options after Fontan failure

Comparison of extracardiac conduit and lateral tunnel for functional single-ventricle patients: A meta-analysis

“…In this meta‐analysis, it showed that there were no significant differences in early mortality, long‐term mortality, and the incidence of Fontan takedown/revision between EC and LT groups, in accordance with other reports . The Fontan takedown was mostly performed early after Fontan surgery with high mortality rate . The postoperative elevated ventricular end‐diastolic pressure and prolonged cardiopulmonary bypass time are considered as risk factors for Fontan takedown .…”

“…37,38 The Fontan takedown was mostly performed early after Fontan surgery with high mortality rate. 39 The postoperative elevated ventricular end-diastolic pressure and prolonged EC can be performed in the absence of extracorporeal circulation to decrease the generation of pro-inflammatory cytokines and vasoactive substances, in order to protect the myocardial, coagulation, and pulmonary vascular systems. 41 It is reported [42][43][44] that prolonged cardiac arrest time and CBP time are risk factors for surgical failure and early mortality of Fontan's procedure.…”

Rescuing the failing Fontan: Table 1

“…Dr van Melle and associates from the European Congenital Heart Surgeons Association (ECHSA) are to be congratulated on their multicenter study on the treatment of failed Fontan patients 1. With the Fontan operation now being 40 years old surgeons are seeing the full spectrum of Fontan circulation failures 2.…”

“…These are all critically ill patients with high mortality rates in all three groups. A summary of their results is shown in table 1 (Results of Surgical Intervention for the failing Fontan) 1. The immediate conclusion looking at these numbers is that all of the surgical ‘rescue’ strategies have a very high early and late mortality.…”

Fontan conversion is a dated approach to the failing Fontan

“…We read with great interest the report by van Melle et al 1 who conducted a retrospective multicentre European study to assess surgical options for the failing Fontan. First, we would like to acknowledge the effort made to bring together the results of these infrequently performed, difficult interventions.…”