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Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation.
Thorac Cardiovasc Surg. 2015 Aug; 63(5):380-7.TC

Abstract

BACKGROUND

Facing longer follow-up of patients after Fontan operation, Fontan conversion was proposed to treat failing Fontan circulation. We reviewed our patients who reached up to 42 years of age.

METHODS

Fifteen consecutive patients underwent Fontan conversion to extracardiac conduit combined with biatrial maze procedure between October 2006 and January 2014. Mean age at conversion was 30.9 ± 5.6 years and mean interval from primary Fontan palliation to conversion was 23.2 ± 3.3 years.

RESULTS

There was one early death. Ten of 14 survivors were extubated within 24 hours, and 11 were discharged from intensive care unit (ICU) within 7 days. The impaired left ventricular function, presented in four patients prior to surgery, improved from EF 43.8 to 54.8% (p = 0.02). During follow-up time of 3.6 ± 2.3 years after conversion, there was no late death and no reoperation. Two patients developed recurrent atrial arrhythmia. Older age at Fontan procedure, lower left ventricular function, higher New York Heart Association (NYHA) class, and anatomy other than tricuspid atresia emerged as risk factors for longer ICU stay.

CONCLUSION

Fontan conversion improved the functional status in almost all patients. A concomitant maze procedure effectively eliminated atrial arrhythmia. This procedure provides a benefit even for older patients if all additional cardiac pathologies are addressed.

Authors+Show Affiliations

Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25803119

Citation

Ono, Masamichi, et al. "Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients With Failing Fontan Circulation." The Thoracic and Cardiovascular Surgeon, vol. 63, no. 5, 2015, pp. 380-7.
Ono M, Cleuziou J, Kasnar-Samprec J, et al. Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation. Thorac Cardiovasc Surg. 2015;63(5):380-7.
Ono, M., Cleuziou, J., Kasnar-Samprec, J., Burri, M., Hepp, V., Vogt, M., Lange, R., Schreiber, C., & Hörer, J. (2015). Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation. The Thoracic and Cardiovascular Surgeon, 63(5), 380-7. https://doi.org/10.1055/s-0035-1548735
Ono M, et al. Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients With Failing Fontan Circulation. Thorac Cardiovasc Surg. 2015;63(5):380-7. PubMed PMID: 25803119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation. AU - Ono,Masamichi, AU - Cleuziou,Julie, AU - Kasnar-Samprec,Jelena, AU - Burri,Melchior, AU - Hepp,Vanessa, AU - Vogt,Manfred, AU - Lange,Rüdiger, AU - Schreiber,Christian, AU - Hörer,Jürgen, Y1 - 2015/03/24/ PY - 2015/3/25/entrez PY - 2015/3/25/pubmed PY - 2016/5/14/medline SP - 380 EP - 7 JF - The Thoracic and cardiovascular surgeon JO - Thorac Cardiovasc Surg VL - 63 IS - 5 N2 - BACKGROUND: Facing longer follow-up of patients after Fontan operation, Fontan conversion was proposed to treat failing Fontan circulation. We reviewed our patients who reached up to 42 years of age. METHODS: Fifteen consecutive patients underwent Fontan conversion to extracardiac conduit combined with biatrial maze procedure between October 2006 and January 2014. Mean age at conversion was 30.9 ± 5.6 years and mean interval from primary Fontan palliation to conversion was 23.2 ± 3.3 years. RESULTS: There was one early death. Ten of 14 survivors were extubated within 24 hours, and 11 were discharged from intensive care unit (ICU) within 7 days. The impaired left ventricular function, presented in four patients prior to surgery, improved from EF 43.8 to 54.8% (p = 0.02). During follow-up time of 3.6 ± 2.3 years after conversion, there was no late death and no reoperation. Two patients developed recurrent atrial arrhythmia. Older age at Fontan procedure, lower left ventricular function, higher New York Heart Association (NYHA) class, and anatomy other than tricuspid atresia emerged as risk factors for longer ICU stay. CONCLUSION: Fontan conversion improved the functional status in almost all patients. A concomitant maze procedure effectively eliminated atrial arrhythmia. This procedure provides a benefit even for older patients if all additional cardiac pathologies are addressed. SN - 1439-1902 UR - https://www.unboundmedicine.com/medline/citation/25803119/Conversion_to_Total_Cavopulmonary_Connection_Improves_Functional_Status_Even_in_Older_Patients_with_Failing_Fontan_Circulation_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0035-1548735 DB - PRIME DP - Unbound Medicine ER -