American Surgical Association

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Topic: F. Clinical Cardiothoracic/Vascular

The Fontan Operation in the Current Era: A 15 Year Single Institution Experience

Jennifer C Hirsch, Timothy Lee, Sepand Salehian, Caren Goldberg, Richard G. Ohye, Edward L. Bove, Eric J. Devaney
University of Michigan, Ann Arbor, MI

Objective: Single ventricle palliation with the Fontan procedure has been performed for decades. We reviewed 636 patients undergoing a Fontan procedure at a single institution to evaluate current risk factors for mortality and morbidity.
Methods: A cross-sectional retrospective study was performed for all Fontan procedures between July 1992 and June 2007. Early and actuarial outcome were evaluated using chi-square and Wilcoxon rank sum.
Results: Anatomy included left ventricular hypoplasia in 63 % and right ventricular hypoplasia in 37%. 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 pre-operative hemodynamics did not predict early or late survival. Aortic cross clamp (XC) time >32 minutes (median) was associated with decreased early and late survival (p=0.01 and p=0.002, respectively). Fontan takedown was required in 3% and protein losing enteropathy (PLE) occurred in 7%. At follow up, 98% of patients were either NYHA class I or II and 87% were in normal sinus rhythm with no difference between LT and EC groups. Patients with chest tube drainage > 2 weeks had an increased risk of PLE (p<0.0001) and diminished long-term survival (p<0.0001).
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 long-term survival. There was a low prevalence of late rhythm disturbances and other complications.

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