The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study

Rossi, Elena; Frigo, Anna Chiara; Reffo, Elena; Cabrelle, Giulio; Castaldi, Biagio; Salvo, Giovanni Di; Vida, Vladimiro L.; Padalino, Massimo A.

doi:10.1093/ejcts/ezab194

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Rossi et al In their study of ventricular morphology in patients undergoing the Fontan procedure, they concluded that having an additional ventricle did not signi cantly differ in morbidity or mortality [35]. This retrospective study reviewed all patients who underwent the Fontan operation over a remarkably long period of 40 years.…”

Section: Discussionmentioning

confidence: 98%

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Fontan Surgery Instead of Biventricular Repair in Complex Cardiac Anomalies: A Good Alternative

Polat

Ertürk

Uzunhan

et al. 2022

Preprint

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Background The Fontan operation has improved the survival of children born with congenital heart disease with single ventricle physiology. The most widely adopted variations of the Fontan procedure are the extracardiac conduit (ECC), the lateral tunnel (LT) ve the intra/extracardiac conduit with fenestration. Despite advances in the treatment and prevention of early and late complications that may develop after Fontan surgery, morbidity still remains an important problem. Methods 304 patients who underwent Fontan surgery in our center between 1995–2022 were included in our study. The complications that developed in patients who underwent primary Fontan or lateral tunnel surgery and extracardiac conduit Fontan application were compared. Results Classic Fontan surgery and lateral tunnel surgery were performed in 26 of the patients, and extracardiac Fontan surgery was performed in 278 patients. 218 of 304 cases were patients with single ventricular pathology. 86 cases were patients with two ventricular morphologies but complex cardiac pathology. When complications between Fontan procedures were compared in our study, prolonged pleural effusion was found more frequently in patients with extracardiac disease after Fontan surgery. Conclusion There are unresolved questions regarding the choice of Fontan procedures and their impact on complication development. Palliative surgical operations aimed at the preparation of the fontan circulation lead to the preparation of the pulmonary vascular bed and the preservation of ventricular function. Early and long-term complications in Fontan surgery affect the survival of patients. In our study, we wanted to contribute to the literature by presenting our 27 years of experience in Fontan surgery.

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Section: Discussionmentioning

confidence: 98%

“…In their study of ventricular morphology in patients undergoing the Fontan procedure, they concluded that having an additional ventricle did not signi cantly differ in morbidity or mortality [35].…”

Section: Rossi Et Almentioning

confidence: 99%

Fontan Surgery Instead of Biventricular Repair in Complex Cardiac Anomalies: A Good Alternative

Polat

Ertürk

Uzunhan

et al. 2022

Preprint

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“…This result supports those of previous studies. 7,8 Additionally, our study explored their findings further with the results of hemodynamic data such as ventricular EDP and exercise testing. Compared with the SV group, the 2V group exhibited no significant difference in VO 2 or cardiac performance, except for a higher cardiac index.…”

Section: Commentsmentioning

confidence: 97%

“…This finding is relevant when the Fontan procedure is considered an alternative to anatomical repair in patients with complex “two-ventricle” morphologies. 7,8 However, both groups only reported significant differences in mortality and morbidity rates. Clinical outcomes need to be correlated with hemodynamic data, such as ventricular end-diastolic pressure (EDP), pulmonary artery pressure, transpulmonary gradient, and exercise testing, to explore the differences between these procedures further.…”

Section: Introductionmentioning

confidence: 95%

Impact of the Rudimentary Chamber on Outcomes in Fontan Patients

Miwa,

Tsumura,

Kanaya

et al. 2024

World J Pediatr Congenit Heart Surg

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Background: We sought to evaluate the influence of the rudimentary ventricle on long-term outcomes after the Fontan operation, focusing on exercise capacity and cardiac performance. Methods: Between 1995 and 2021, 290 patients underwent a total cavopulmonary connection. “Two-ventricle” Fontan circulation was defined as a rudimentary ventricle >30% of the dominant ventricle or >50% of its predicted normal value. This cohort was compared with patients with single-ventricle Fontan circulation. The primary endpoint was Fontan failure, and the secondary endpoints were VO2 and cardiac catheterization data at ten years postoperatively. Results: The median follow-up after the Fontan operation was 7.9 years (interquartile range: 1.9-13.9). No significant difference was found in Fontan failure-free survival between the “two-ventricle” Fontan circulation group and the single-ventricle Fontan circulation group (83/91, 93% vs 156/199, 78%), respectively at 20 years; P = .11). No significant difference was found in VO2 or cardiac performance except cardiac index, with 2.9 (2.3-4.8) versus 2.5 (2.3-4.3) L/min/m2 ( P = .047). Fifty-one patients in the “two-ventricle” Fontan circulation group were followed up for over ten years after the Fontan operation. In the subgroup analysis of this cohort, the rudimentary ventricular end-diastolic volume/dominant ventricular end-diastolic volume ratio showed a significant positive correlation with dominant ventricular end-diastolic pressure (r = 0.58 [95% CI 0.35-0.74], P = .002) and a significant negative correlation with VO2 (r = −0.61 [95% CI −0.80 to −0.28], P = .001). Conclusions: The rudimentary ventricle was not significantly associated with any clinical disadvantages regarding Fontan failure. However, a large rudimentary ventricle was significantly associated with higher end-diastolic pressure and lower exercise capacity.

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“…There was also good distribution of dominant ventricle type with 78 patients having a dominant right ventricle, 115 patients having a dominant left ventricle and 17 patients with an undetermined ventricle. The authors found no difference in early complications after Fontan or early death for those with biventricular Fontan in comparison to single ventricle Fontan [ 36 ].…”

Section: Dıscussıonmentioning

confidence: 99%

27 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital

Polat

Ertürk

Uzunhan

et al. 2023

J Cardiothorac Surg

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Background The Fontan operation has improved the survival of children born with congenital heart disease with single ventricle physiology. The most widely adopted variations of the Fontan procedure are the extracardiac conduit, the lateral tunnel ve the intra/extracardiac conduit with fenestration. Despite advances in the treatment and prevention of early and late complications that may develop after Fontan surgery, morbidity still remains an important problem. Methods 304 patients who underwent Fontan surgery in our center between 1995 and 2022 were included in our study. The complications that developed in patients who underwent primary Fontan or lateral tunnel surgery and extracardiac conduit Fontan application were compared. Results Classic Fontan surgery and lateral tunnel surgery were performed in 26 of the patients, and extracardiac Fontan surgery was performed in 278 patients. 218 of 304 cases were patients with single ventricular pathology. 86 cases were patients with two ventricular morphologies but complex cardiac pathology. Fenestration was performed in only 6 patients, other patients did not require fenestration. The mean follow-up period of our patients was 12 years (3 months–27 years). When the complications between Fontan procedures were compared in our study, it was found that the length of hospital stay and mortality were statistically significantly reduced in patients who underwent extracardiac Fontan surgery. There was no significant difference in terms of complications that can be seen after Fontan surgery and the length of stay in the intensive care unit. Conclusion Fontan complex is a palliative surgery for children with complex heart disease. Palliative surgical operations aimed at the preparation of the Fontan circulation lead to the preparation of the pulmonary vascular bed and the preservation of ventricular function. The techniques applied in Fontan surgery affect the early and long-term complications and the survival of the patients. In our study, when we examined the patients who extracardiac conduit Fontan procedure for the non-cardiac route, we found that mortality and morbidity were minimal.

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The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study

Cited by 8 publications

References 24 publications

Fontan Surgery Instead of Biventricular Repair in Complex Cardiac Anomalies: A Good Alternative

Fontan Surgery Instead of Biventricular Repair in Complex Cardiac Anomalies: A Good Alternative

Impact of the Rudimentary Chamber on Outcomes in Fontan Patients

27 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital

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