The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period

Abstract

Mortality following Fontan surgery has significantly decreased; however, postoperative morbidity rates remain high and can lead to unfavorable outcomes. Early post-Fontan pathway obstructions can result in persistent pleural effusion, cyanosis, and low cardiac output syndrome (LCOS). Transcatheter interventions can be employed as an alternative to early re-surgery for their treatment. Over a 13-year study period, early (<30 days) transcatheter interventions were performed on 37 (10.4%) of 344 patients who underwent Fontan surgery. Case notes and procedure records were retrospectively reviewed. Among them, 33 patients were treated solely with transcatheter procedures, while 3 were lost during early ICU follow-up. 30 patients were successfully treated with purely transcatheter methods and were discharged. After left pulmonary artery (LPA) balloon angioplasty, one patient required emergency surgery. In another case, LPA stent implantation resulted in thrombosis followed by localized tissue plasminogen activator (TPA) administration and subsequent middle cerebral artery (MCA) stroke. In four cases, transcatheter interventions were inadequate, necessitating early re-surgery, of which two patients died. The median age at Fontan operation was 4.8 (IQR:4-9.4) year, with a median weight of 16.5 (IQR:15-25.2) kg. Among the 23 patients with persistent pleural effusion/ascites, transcatheter procedures; fenestration dilatation in 14 patients, LPA stent placement in 7 patients, right pulmonary artery (RPA) stent placement in 4 patients, occlusion of aortopulmonary (AP) collaterals in 5 patients. All 8 patients diagnosed with LCOS underwent fenestration dilation. Procedural mortality was not observed. Early post-Fontan transcatheter interventions appear safe and effective.