Tags

Type your tag names separated by a space and hit enter

Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis.
Eur J Cardiothorac Surg. 2005 Oct; 28(4):529-35.EJ

Abstract

OBJECTIVE

To investigate survival and risk factors influencing intermediate outcome after the Fontan procedure.

METHODS

Retrospective analysis of 122 patients operated between April 1991 and September 2002. Poor outcome was defined as late death or poor functional status (intractable supraventricular arrhythmias/NYHA 3-4) necessitating revision surgery.

RESULTS

64(52%) patients had an intermediate bi-directional cavo-pulmonary shunt (BCPS). 91 (76%) patients had a lateral tunnel total cavo-pulmonary connection, 21(17%) patients had an atrio-pulmonary connection and 10 (8%)patients had a Kawashima connection. There were 6 (5%)early deaths. Over a median follow up of 54 months (1-133), 12 (10%)patients have had surgical revision for poor functional status. There were 7 (6%) late deaths, 5 of which occurred after revision surgery. Univariate analysis identified older age at operation (>4 years) (P=0.04), higher postoperative pulmonary artery pressure at 24h (P=0.012), arrhythmia postoperatively (P=0.03) or during follow-up (P=0.01) and the requirement for anticoagulation during follow-up (P=0.03) as significant predictors of poorer outcome. Patients who had an intermediate BCPS (P=0.002) or Norwood Stage 1 (P=0.05) had a better outcome. Multivariate analysis identified an intermediate Glenn shunt and lower postoperative pulmonary artery pressure as significant predictors of better outcome. Actuarial freedom from death or revision is 93% (+/-2), 88% (+/-3), 86% (+/-4) and 69% (+/-7) at 1, 5, 7 and 9 years respectively. Actuarial freedom from death or revision for the lateral tunnel group is 92% (+/-2), 89% (+/-3), 85% (+/-5) and 66% (+/-10) respectively.

CONCLUSION

Atrio-pulmonary connection results in a higher incidence of arrhythmias and failure than the lateral tunnel Fontan. Even in patients with a lateral tunnel Fontan there is a continuing hazard phase in the intermediate term. Mid-term outcome appears to be favorably influenced by an intermediate BCPS.

Authors+Show Affiliations

Department of Congenital Heart Disease, Guy's Hospital, Guy's and St Thomas Hospitals NHS Trust, St Thomas Street, London SE1 9RT, UK. nelson.a@bigfoot.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16135410

Citation

Alphonso, Nelson, et al. "Intermediate-term Outcome Following the Fontan Operation: a Survival, Functional and Risk-factor Analysis." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 28, no. 4, 2005, pp. 529-35.
Alphonso N, Baghai M, Sundar P, et al. Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. Eur J Cardiothorac Surg. 2005;28(4):529-35.
Alphonso, N., Baghai, M., Sundar, P., Tulloh, R., Austin, C., & Anderson, D. (2005). Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 28(4), 529-35.
Alphonso N, et al. Intermediate-term Outcome Following the Fontan Operation: a Survival, Functional and Risk-factor Analysis. Eur J Cardiothorac Surg. 2005;28(4):529-35. PubMed PMID: 16135410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. AU - Alphonso,Nelson, AU - Baghai,Max, AU - Sundar,Prem, AU - Tulloh,Robert, AU - Austin,Conal, AU - Anderson,David, PY - 2004/12/10/received PY - 2005/05/10/revised PY - 2005/06/28/accepted PY - 2005/9/2/pubmed PY - 2006/3/3/medline PY - 2005/9/2/entrez SP - 529 EP - 35 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 28 IS - 4 N2 - OBJECTIVE: To investigate survival and risk factors influencing intermediate outcome after the Fontan procedure. METHODS: Retrospective analysis of 122 patients operated between April 1991 and September 2002. Poor outcome was defined as late death or poor functional status (intractable supraventricular arrhythmias/NYHA 3-4) necessitating revision surgery. RESULTS: 64(52%) patients had an intermediate bi-directional cavo-pulmonary shunt (BCPS). 91 (76%) patients had a lateral tunnel total cavo-pulmonary connection, 21(17%) patients had an atrio-pulmonary connection and 10 (8%)patients had a Kawashima connection. There were 6 (5%)early deaths. Over a median follow up of 54 months (1-133), 12 (10%)patients have had surgical revision for poor functional status. There were 7 (6%) late deaths, 5 of which occurred after revision surgery. Univariate analysis identified older age at operation (>4 years) (P=0.04), higher postoperative pulmonary artery pressure at 24h (P=0.012), arrhythmia postoperatively (P=0.03) or during follow-up (P=0.01) and the requirement for anticoagulation during follow-up (P=0.03) as significant predictors of poorer outcome. Patients who had an intermediate BCPS (P=0.002) or Norwood Stage 1 (P=0.05) had a better outcome. Multivariate analysis identified an intermediate Glenn shunt and lower postoperative pulmonary artery pressure as significant predictors of better outcome. Actuarial freedom from death or revision is 93% (+/-2), 88% (+/-3), 86% (+/-4) and 69% (+/-7) at 1, 5, 7 and 9 years respectively. Actuarial freedom from death or revision for the lateral tunnel group is 92% (+/-2), 89% (+/-3), 85% (+/-5) and 66% (+/-10) respectively. CONCLUSION: Atrio-pulmonary connection results in a higher incidence of arrhythmias and failure than the lateral tunnel Fontan. Even in patients with a lateral tunnel Fontan there is a continuing hazard phase in the intermediate term. Mid-term outcome appears to be favorably influenced by an intermediate BCPS. SN - 1010-7940 UR - https://www.unboundmedicine.com/medline/citation/16135410/Intermediate_term_outcome_following_the_fontan_operation:_a_survival_functional_and_risk_factor_analysis_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2005.06.035 DB - PRIME DP - Unbound Medicine ER -