Document Detail


Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis.
MedLine Citation:
PMID:  16135410     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate survival and risk factors influencing intermediate outcome after the Fontan procedure. METHODS: Retrospective analysis of 122 patients operated between April 1991 and September 2002. Poor outcome was defined as late death or poor functional status (intractable supraventricular arrhythmias/NYHA 3-4) necessitating revision surgery. RESULTS: 64(52%) patients had an intermediate bi-directional cavo-pulmonary shunt (BCPS). 91 (76%) patients had a lateral tunnel total cavo-pulmonary connection, 21(17%) patients had an atrio-pulmonary connection and 10 (8%)patients had a Kawashima connection. There were 6 (5%)early deaths. Over a median follow up of 54 months (1-133), 12 (10%)patients have had surgical revision for poor functional status. There were 7 (6%) late deaths, 5 of which occurred after revision surgery. Univariate analysis identified older age at operation (>4 years) (P=0.04), higher postoperative pulmonary artery pressure at 24h (P=0.012), arrhythmia postoperatively (P=0.03) or during follow-up (P=0.01) and the requirement for anticoagulation during follow-up (P=0.03) as significant predictors of poorer outcome. Patients who had an intermediate BCPS (P=0.002) or Norwood Stage 1 (P=0.05) had a better outcome. Multivariate analysis identified an intermediate Glenn shunt and lower postoperative pulmonary artery pressure as significant predictors of better outcome. Actuarial freedom from death or revision is 93% (+/-2), 88% (+/-3), 86% (+/-4) and 69% (+/-7) at 1, 5, 7 and 9 years respectively. Actuarial freedom from death or revision for the lateral tunnel group is 92% (+/-2), 89% (+/-3), 85% (+/-5) and 66% (+/-10) respectively. CONCLUSION: Atrio-pulmonary connection results in a higher incidence of arrhythmias and failure than the lateral tunnel Fontan. Even in patients with a lateral tunnel Fontan there is a continuing hazard phase in the intermediate term. Mid-term outcome appears to be favorably influenced by an intermediate BCPS.
Authors:
Nelson Alphonso; Max Baghai; Prem Sundar; Robert Tulloh; Conal Austin; David Anderson
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  28     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-23     Completed Date:  2006-03-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  529-35     Citation Subset:  IM    
Affiliation:
Department of Congenital Heart Disease, Guy's Hospital, Guy's and St Thomas Hospitals NHS Trust, St Thomas Street, London SE1 9RT, UK. nelson.a@bigfoot.com
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Arrhythmias, Cardiac / etiology
Blood Coagulation Disorders / drug therapy,  etiology
Child
Child, Preschool
Female
Fontan Procedure / methods*,  mortality
Heart Defects, Congenital / mortality,  physiopathology,  surgery*
Heart Valves / abnormalities,  surgery
Humans
Infant
Male
Postoperative Complications / etiology
Preoperative Care / methods
Reoperation
Retrospective Studies
Risk Factors
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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