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Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation.
J Thorac Cardiovasc Surg. 2001 Nov; 122(5):863-71.JT

Abstract

OBJECTIVES

Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We review our experience with conversion to total cavopulmonary artery connections and arrhythmia surgery.

METHODS

Between 1994 and 2001, 40 patients underwent Fontan conversion and arrhythmia surgery. Significant hemodynamic lesions such as aortic aneurysm (n = 1), atrioventricular valve insufficiency (n = 8), and pulmonary arterioplasty (n = 9) were repaired concomitantly. Thirty-four patients were in New York Heart Association class III or IV. Mean age at the original Fontan operation was 7.5 +/- 6.5 years and mean age at Fontan conversion was 18.7 +/- 9.0 years. Arrhythmia surgery has evolved from isthmus cryoablation in 10 patients to right-sided maze in 16 patients for atrial reentry tachycardia. The maze-Cox III operation was used for 14 patients with atrial fibrillation. Atrial (n = 33) and dual-chamber (n = 5) pacemakers were placed.

RESULTS

There has been no early mortality. Chest tubes were removed on postoperative day 9.0 +/- 6.0. Hospital stay was 11.8 +/- 6.6 days. Three patients required cardiac transplantation at 8 days, 9 months, and 33 months postoperatively. There was 1 death 2 years postoperatively from acute myocardial infarction. For the entire series, arrhythmia recurrence is 12.5%, with only 10% of patients receiving long-term antiarrhythmic medications; these patients were among the first 8 patients in our series. Most patients are in New York Heart Association class I or II. Bruce protocol in 12 patients showed increased tolerance (P <.05).

CONCLUSIONS

Fontan conversion to total cavopulmonary connection with concomitant arrhythmia surgery is excellent therapy for patients whose Fontan repair has failed. Fontan conversion is safe, improves New York Heart Association class, improves exercise tolerance, and has a low incidence of recurrent arrhythmias.

Authors+Show Affiliations

Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614, USA. c-mavroudis@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11689789

Citation

Mavroudis, C, et al. "Total Cavopulmonary Conversion and Maze Procedure for Patients With Failure of the Fontan Operation." The Journal of Thoracic and Cardiovascular Surgery, vol. 122, no. 5, 2001, pp. 863-71.
Mavroudis C, Backer CL, Deal BJ, et al. Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. J Thorac Cardiovasc Surg. 2001;122(5):863-71.
Mavroudis, C., Backer, C. L., Deal, B. J., Johnsrude, C., & Strasburger, J. (2001). Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. The Journal of Thoracic and Cardiovascular Surgery, 122(5), 863-71.
Mavroudis C, et al. Total Cavopulmonary Conversion and Maze Procedure for Patients With Failure of the Fontan Operation. J Thorac Cardiovasc Surg. 2001;122(5):863-71. PubMed PMID: 11689789.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. AU - Mavroudis,C, AU - Backer,C L, AU - Deal,B J, AU - Johnsrude,C, AU - Strasburger,J, PY - 2001/11/2/pubmed PY - 2002/1/5/medline PY - 2001/11/2/entrez SP - 863 EP - 71 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 122 IS - 5 N2 - OBJECTIVES: Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We review our experience with conversion to total cavopulmonary artery connections and arrhythmia surgery. METHODS: Between 1994 and 2001, 40 patients underwent Fontan conversion and arrhythmia surgery. Significant hemodynamic lesions such as aortic aneurysm (n = 1), atrioventricular valve insufficiency (n = 8), and pulmonary arterioplasty (n = 9) were repaired concomitantly. Thirty-four patients were in New York Heart Association class III or IV. Mean age at the original Fontan operation was 7.5 +/- 6.5 years and mean age at Fontan conversion was 18.7 +/- 9.0 years. Arrhythmia surgery has evolved from isthmus cryoablation in 10 patients to right-sided maze in 16 patients for atrial reentry tachycardia. The maze-Cox III operation was used for 14 patients with atrial fibrillation. Atrial (n = 33) and dual-chamber (n = 5) pacemakers were placed. RESULTS: There has been no early mortality. Chest tubes were removed on postoperative day 9.0 +/- 6.0. Hospital stay was 11.8 +/- 6.6 days. Three patients required cardiac transplantation at 8 days, 9 months, and 33 months postoperatively. There was 1 death 2 years postoperatively from acute myocardial infarction. For the entire series, arrhythmia recurrence is 12.5%, with only 10% of patients receiving long-term antiarrhythmic medications; these patients were among the first 8 patients in our series. Most patients are in New York Heart Association class I or II. Bruce protocol in 12 patients showed increased tolerance (P <.05). CONCLUSIONS: Fontan conversion to total cavopulmonary connection with concomitant arrhythmia surgery is excellent therapy for patients whose Fontan repair has failed. Fontan conversion is safe, improves New York Heart Association class, improves exercise tolerance, and has a low incidence of recurrent arrhythmias. SN - 0022-5223 UR - https://www.unboundmedicine.com/medline/citation/11689789/Total_cavopulmonary_conversion_and_maze_procedure_for_patients_with_failure_of_the_Fontan_operation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(01)79470-6 DB - PRIME DP - Unbound Medicine ER -