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Fontan operation in the current era: a 15-year single institution experience.
Ann Surg. 2008 Sep; 248(3):402-10.AnnS

Abstract

OBJECTIVE

Evaluate current risk factors for mortality and morbidity in patients undergoing the Fontan procedure at a single institution in the current era.

SUMMARY BACKGROUND DATA

An emphasis on early relief of volume and pressure overload culminating in the Fontan procedure has improved patient outcomes for patients with a single ventricle.

METHODS

A cross-sectional retrospective study was performed for 636 primary Fontan procedures between July 1992 and June 2007.

RESULTS

Anatomy included left ventricular hypoplasia in 64% and right ventricular hypoplasia in 36%. A lateral tunnel (LT) was performed in 92% and an extracardiac conduit (EC) in 8%. Hospital survival was 96%. Long-term survival was 97% at a mean follow-up of 50 months (range, 0-173 months). Ventricular anatomy and preoperative hemodynamics did not predict early or late survival. Longer aortic cross clamp (XC) time was associated with decreased late survival (P = 0.01). Fontan takedown was required in 3% and protein-losing enteropathy (PLE) developed in 6%. At follow-up, 98% of patients were either NYHA class I or II and 87% were in normal sinus rhythm. Patients with chest tube drainage >2 weeks had an increased risk of PLE (P < 0.0001) and diminished short- and long-term survival (P = 0.026 and P < 0.0001, respectively).

CONCLUSIONS

The Fontan procedure can be performed with low risk regardless of ventricular anatomy. Duration of XC time is associated with survival. Prolonged CT drainage correlates with late PLE and diminished survival. There was a low prevalence of late rhythm disturbances and other complications.

Authors+Show Affiliations

Department of Surgery, Section of Cardiac Surgery and daggerDepartment of Pediatrics, Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.No 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

18791360

Citation

Hirsch, Jennifer C., et al. "Fontan Operation in the Current Era: a 15-year Single Institution Experience." Annals of Surgery, vol. 248, no. 3, 2008, pp. 402-10.
Hirsch JC, Goldberg C, Bove EL, et al. Fontan operation in the current era: a 15-year single institution experience. Ann Surg. 2008;248(3):402-10.
Hirsch, J. C., Goldberg, C., Bove, E. L., Salehian, S., Lee, T., Ohye, R. G., & Devaney, E. J. (2008). Fontan operation in the current era: a 15-year single institution experience. Annals of Surgery, 248(3), 402-10. https://doi.org/10.1097/SLA.0b013e3181858286
Hirsch JC, et al. Fontan Operation in the Current Era: a 15-year Single Institution Experience. Ann Surg. 2008;248(3):402-10. PubMed PMID: 18791360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fontan operation in the current era: a 15-year single institution experience. AU - Hirsch,Jennifer C, AU - Goldberg,Caren, AU - Bove,Edward L, AU - Salehian,Sepand, AU - Lee,Timothy, AU - Ohye,Richard G, AU - Devaney,Eric J, PY - 2008/9/16/pubmed PY - 2008/9/27/medline PY - 2008/9/16/entrez SP - 402 EP - 10 JF - Annals of surgery JO - Ann Surg VL - 248 IS - 3 N2 - OBJECTIVE: Evaluate current risk factors for mortality and morbidity in patients undergoing the Fontan procedure at a single institution in the current era. SUMMARY BACKGROUND DATA: An emphasis on early relief of volume and pressure overload culminating in the Fontan procedure has improved patient outcomes for patients with a single ventricle. METHODS: A cross-sectional retrospective study was performed for 636 primary Fontan procedures between July 1992 and June 2007. RESULTS: Anatomy included left ventricular hypoplasia in 64% and right ventricular hypoplasia in 36%. A lateral tunnel (LT) was performed in 92% and an extracardiac conduit (EC) in 8%. Hospital survival was 96%. Long-term survival was 97% at a mean follow-up of 50 months (range, 0-173 months). Ventricular anatomy and preoperative hemodynamics did not predict early or late survival. Longer aortic cross clamp (XC) time was associated with decreased late survival (P = 0.01). Fontan takedown was required in 3% and protein-losing enteropathy (PLE) developed in 6%. At follow-up, 98% of patients were either NYHA class I or II and 87% were in normal sinus rhythm. Patients with chest tube drainage >2 weeks had an increased risk of PLE (P < 0.0001) and diminished short- and long-term survival (P = 0.026 and P < 0.0001, respectively). CONCLUSIONS: The Fontan procedure can be performed with low risk regardless of ventricular anatomy. Duration of XC time is associated with survival. Prolonged CT drainage correlates with late PLE and diminished survival. There was a low prevalence of late rhythm disturbances and other complications. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/18791360/Fontan_operation_in_the_current_era:_a_15_year_single_institution_experience_ L2 - https://Insights.ovid.com/pubmed?pmid=18791360 DB - PRIME DP - Unbound Medicine ER -