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J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes.
Ann Thorac Surg. 2007 Nov; 84(5):1457-65; discussion 1465-6.AT

Abstract

BACKGROUND

The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome.

METHODS

Since 1994, 111 patients (mean age 22.5 +/- 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III).

RESULTS

There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 +/- 12.1 days. Mean cross-clamp time was 70.8 +/- 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3).

CONCLUSIONS

Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.

Authors+Show Affiliations

Division of Cardiovascular Thoracic Surgery, Children's Memorial Hospital, Northwestern University, Chicago Illinois 60614, USA. cmavroudis@childrensmemorial.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17954046

Citation

Mavroudis, Constantine, et al. "J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery. 111 Fontan Conversions With Arrhythmia Surgery: Surgical Lessons and Outcomes." The Annals of Thoracic Surgery, vol. 84, no. 5, 2007, pp. 1457-65; discussion 1465-6.
Mavroudis C, Deal BJ, Backer CL, et al. J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes. Ann Thorac Surg. 2007;84(5):1457-65; discussion 1465-6.
Mavroudis, C., Deal, B. J., Backer, C. L., Stewart, R. D., Franklin, W. H., Tsao, S., Ward, K. M., & DeFreitas, R. A. (2007). J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes. The Annals of Thoracic Surgery, 84(5), 1457-65; discussion 1465-6.
Mavroudis C, et al. J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery. 111 Fontan Conversions With Arrhythmia Surgery: Surgical Lessons and Outcomes. Ann Thorac Surg. 2007;84(5):1457-65; discussion 1465-6. PubMed PMID: 17954046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes. AU - Mavroudis,Constantine, AU - Deal,Barbara J, AU - Backer,Carl L, AU - Stewart,Robert D, AU - Franklin,Wayne H, AU - Tsao,Sabrina, AU - Ward,Kendra M, AU - DeFreitas,R Andrew, PY - 2007/01/26/received PY - 2007/06/22/revised PY - 2007/06/26/accepted PY - 2007/10/24/pubmed PY - 2007/11/9/medline PY - 2007/10/24/entrez SP - 1457-65; discussion 1465-6 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 84 IS - 5 N2 - BACKGROUND: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome. METHODS: Since 1994, 111 patients (mean age 22.5 +/- 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III). RESULTS: There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 +/- 12.1 days. Mean cross-clamp time was 70.8 +/- 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3). CONCLUSIONS: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17954046/J__Maxwell_Chamberlain_Memorial_Paper_for_congenital_heart_surgery__111_Fontan_conversions_with_arrhythmia_surgery:_surgical_lessons_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)01386-0 DB - PRIME DP - Unbound Medicine ER -