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Clinical outcome of the Fontan operation in patients with impaired ventricular function.
Eur J Cardiothorac Surg. 2009 Oct; 36(4):683-7.EJ

Abstract

OBJECTIVE

Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function.

METHODS

A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991 and 2007.

RESULTS

Twenty-nine (13%) of the 217 patients had an impaired ventricular function (ejection fraction (EF) <50%). The median age at the time of the operation was 3 (range: 1-31 years) years. There were five adult patients. The ventricular morphology was right in 20 patients (including five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) in nine patients. Heterotaxy syndrome was present in eight patients. Previous surgical interventions included bidirectional Glenn anastomoses in 24, modified Blalock-Taussig shunts in two and pulmonary artery banding in two. The preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular valve regurgitation was noted in four patients. The percutaneous oxygen saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 patients underwent the Fontan operation without any early mortality. There were two late mortalities and two re-operations. EF was maintained at 59+/-15% at a median follow-up of 7.5 (range: 1-19) years. The percent normal systemic ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 pgml(-1)), respectively. Three patients developed congestive heart failure, seven had arrhythmia and two developed protein-losing enteropathy. The New York Heart Association (NYHA) class functional class is I in 21 patients, II in five and III in one.

CONCLUSIONS

Acceptable clinical outcomes were observed at an intermediate follow-up of the Fontan operation in patients with an impaired ventricular function.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama City, Okayama 700-8558, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

19713119

Citation

Kotani, Yasuhiro, et al. "Clinical Outcome of the Fontan Operation in Patients With Impaired Ventricular Function." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 36, no. 4, 2009, pp. 683-7.
Kotani Y, Kasahara S, Fujii Y, et al. Clinical outcome of the Fontan operation in patients with impaired ventricular function. Eur J Cardiothorac Surg. 2009;36(4):683-7.
Kotani, Y., Kasahara, S., Fujii, Y., Yoshizumi, K., Oshima, Y., Otsuki, S., Akagi, T., & Sano, S. (2009). Clinical outcome of the Fontan operation in patients with impaired ventricular function. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 36(4), 683-7. https://doi.org/10.1016/j.ejcts.2009.04.042
Kotani Y, et al. Clinical Outcome of the Fontan Operation in Patients With Impaired Ventricular Function. Eur J Cardiothorac Surg. 2009;36(4):683-7. PubMed PMID: 19713119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome of the Fontan operation in patients with impaired ventricular function. AU - Kotani,Yasuhiro, AU - Kasahara,Shingo, AU - Fujii,Yasuhiro, AU - Yoshizumi,Ko, AU - Oshima,Yu, AU - Otsuki,Shin-Ichi, AU - Akagi,Teiji, AU - Sano,Shunji, Y1 - 2009/08/26/ PY - 2008/09/15/received PY - 2009/04/14/revised PY - 2009/04/17/accepted PY - 2009/8/29/entrez PY - 2009/8/29/pubmed PY - 2010/2/27/medline SP - 683 EP - 7 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 36 IS - 4 N2 - OBJECTIVE: Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function. METHODS: A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991 and 2007. RESULTS: Twenty-nine (13%) of the 217 patients had an impaired ventricular function (ejection fraction (EF) <50%). The median age at the time of the operation was 3 (range: 1-31 years) years. There were five adult patients. The ventricular morphology was right in 20 patients (including five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) in nine patients. Heterotaxy syndrome was present in eight patients. Previous surgical interventions included bidirectional Glenn anastomoses in 24, modified Blalock-Taussig shunts in two and pulmonary artery banding in two. The preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular valve regurgitation was noted in four patients. The percutaneous oxygen saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 patients underwent the Fontan operation without any early mortality. There were two late mortalities and two re-operations. EF was maintained at 59+/-15% at a median follow-up of 7.5 (range: 1-19) years. The percent normal systemic ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 pgml(-1)), respectively. Three patients developed congestive heart failure, seven had arrhythmia and two developed protein-losing enteropathy. The New York Heart Association (NYHA) class functional class is I in 21 patients, II in five and III in one. CONCLUSIONS: Acceptable clinical outcomes were observed at an intermediate follow-up of the Fontan operation in patients with an impaired ventricular function. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/19713119/Clinical_outcome_of_the_Fontan_operation_in_patients_with_impaired_ventricular_function_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1016/j.ejcts.2009.04.042 DB - PRIME DP - Unbound Medicine ER -