- Meeting abstract
- Open Access
30-year experience of Fontan surgery: single-centre's data
© Bezuska et al. 2015
- Published: 16 December 2015
- Acute Heart Failure
- Tracheal Stenosis
- Chest Drain
- Fontan Procedure
- Fontan Circulation
The 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 morbidities.
We report our surgical experience of 30 years in Fontan procedures and the long-term follow-up result.
From January 1985 to January 2015, 80 patients underwent Fontan surgery. Twenty one patient received an atrio-pulmonary Fontan (Group I), 4 patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), 6 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 reintervention or reoperation.
The 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 preoperative pulmonary artery pressure and pulmonary artery resistance were 13 mm Hg (IQR, 11-15) and 1 Wood unit (IQR, 1-1.4) respectively. Fenestration was created in 40 (50%) patients. The median length of stay in intensive care unit, intubation and chest drain stay time were 90 hours (interquartile range [IQR], 46-119), 8 hours (IQR, 6-16) and 18 days (IQR, 12-28) respectively. Early complications were bleeding in 6, taken down of Fontan circulation in 3 and acute heart failure managed by left heart bypass in 1 patient. Late-occurring morbidities included arrhythmias in 6, protein-losing enteropathy in 2, thromboembolism in 2 and tracheal stenosis in 1 patient. Fourteen patients (18%) had redo Fontan procedures.
Our 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.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.