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Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre.
Cardiol Young. 2011 Dec; 21(6):665-9.CY

Abstract

OBJECTIVES

Classical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial.

METHODS

Between the years 2002 and 2009, 15 patients with a median age of 26.2 (12-43) years underwent Fontan conversion operation with concomitant arrhythmia surgery. All were symptomatic and 14 out of the 15 patients had refractory arrhythmias. The duration of pre-operative arrhythmia and the outcome of surgery were correlated to study the impact of delay in surgical intervention on post-operative survival and arrhythmia control.

RESULTS

There were two patients who died in the early post-operative period (13.3%). At the mid-term follow-up, 53 (20-86) months, late atrial arrhythmias had recurred in two of the 13 surviving patients (15.30%) and one patient developed late sinus node dysfunction. The need for anti-arrhythmic drugs decreased considerably from 93.5% to 15.3% on mid-term follow-up. There was no late death or need for cardiac transplantation. The duration of arrhythmia before surgery was prolonged for more than 10 years in patients who died as well as in those who had complications like late recurrence of arrhythmias, dependence on anti-arrhythmic medications, and worsening of ventricular dysfunction.

CONCLUSIONS

Fontan conversion is a well-established treatment option for salvaging the failing atriopulmonary connections. Concomitant arrhythmia surgery effectively resolves the refractory atrial arrhythmias and improves survival, but we need to optimise the timing of Fontan conversion to improve the long-term outcome.

Authors+Show Affiliations

Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center 'E. Malan', University of Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

21615976

Citation

Sridhar, Anuradha, et al. "Fontan Conversion With Concomitant Arrhythmia Surgery for the Failing Atriopulmonary Connections: Mid-term Results From a Single Centre." Cardiology in the Young, vol. 21, no. 6, 2011, pp. 665-9.
Sridhar A, Giamberti A, Foresti S, et al. Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre. Cardiol Young. 2011;21(6):665-9.
Sridhar, A., Giamberti, A., Foresti, S., Cappato, R., García, C. R., Cabrera, N. D., Micheletti, A., Negura, D., Bussadori, C., Butera, G., Frigiola, A., Carminati, M., & Chessa, M. (2011). Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre. Cardiology in the Young, 21(6), 665-9. https://doi.org/10.1017/S1047951111000643
Sridhar A, et al. Fontan Conversion With Concomitant Arrhythmia Surgery for the Failing Atriopulmonary Connections: Mid-term Results From a Single Centre. Cardiol Young. 2011;21(6):665-9. PubMed PMID: 21615976.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre. AU - Sridhar,Anuradha, AU - Giamberti,Alessandro, AU - Foresti,Sara, AU - Cappato,Riccardo, AU - García,Carlos Rubio-Iglesias, AU - Cabrera,Nerea Delgado, AU - Micheletti,Angelo, AU - Negura,Diana, AU - Bussadori,Claudio, AU - Butera,Gianfranco, AU - Frigiola,Alessandro, AU - Carminati,Mario, AU - Chessa,Massimo, Y1 - 2011/05/27/ PY - 2011/5/28/entrez PY - 2011/5/28/pubmed PY - 2012/3/1/medline SP - 665 EP - 9 JF - Cardiology in the young JO - Cardiol Young VL - 21 IS - 6 N2 - OBJECTIVES: Classical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial. METHODS: Between the years 2002 and 2009, 15 patients with a median age of 26.2 (12-43) years underwent Fontan conversion operation with concomitant arrhythmia surgery. All were symptomatic and 14 out of the 15 patients had refractory arrhythmias. The duration of pre-operative arrhythmia and the outcome of surgery were correlated to study the impact of delay in surgical intervention on post-operative survival and arrhythmia control. RESULTS: There were two patients who died in the early post-operative period (13.3%). At the mid-term follow-up, 53 (20-86) months, late atrial arrhythmias had recurred in two of the 13 surviving patients (15.30%) and one patient developed late sinus node dysfunction. The need for anti-arrhythmic drugs decreased considerably from 93.5% to 15.3% on mid-term follow-up. There was no late death or need for cardiac transplantation. The duration of arrhythmia before surgery was prolonged for more than 10 years in patients who died as well as in those who had complications like late recurrence of arrhythmias, dependence on anti-arrhythmic medications, and worsening of ventricular dysfunction. CONCLUSIONS: Fontan conversion is a well-established treatment option for salvaging the failing atriopulmonary connections. Concomitant arrhythmia surgery effectively resolves the refractory atrial arrhythmias and improves survival, but we need to optimise the timing of Fontan conversion to improve the long-term outcome. SN - 1467-1107 UR - https://www.unboundmedicine.com/medline/citation/21615976/Fontan_conversion_with_concomitant_arrhythmia_surgery_for_the_failing_atriopulmonary_connections:_mid_term_results_from_a_single_centre_ L2 - https://www.cambridge.org/core/product/identifier/S1047951111000643/type/journal_article DB - PRIME DP - Unbound Medicine ER -