Survival and predictors of mortality in patients after the Fontan operation

Abstract

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

National outcomes of the Fontan operation with endocardial cushion defect

“…But due to the nature of the data set, the mechanism of the mortality such as acute Fontan failure versus sepsis is not known. These findings agree with previous studies where postoperative complications were independent predictors of a negative outcome after a FO 27–29 . Interestingly, the occurrence of chylothorax was not different between the groups…”

“…These findings agree with previous studies where postoperative complications were independent predictors of a negative outcome after a FO. [27][28][29] Interestingly, the occurrence of chylothorax was not different between the groups Of the 24 patients who did not survive the FO, 42% (10/24 patients) belonged to the ECD group. Also, a time-to-event analysis by the Kaplan-Meir method was done with the length of stay as the time variable and discharge mortality as the event.…”