Document Detail

Results of the modified Fontan procedure are not related to age at operation.
MedLine Citation:
PMID:  19800250     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The modified Fontan procedure represents the final stage for the palliation of hearts with single-ventricle physiology. Different opinions exist regarding the optimal timing of the operation, with most centres advocating early intervention. By contrast, over the past decade, we have progressively increased the age at Fontan operation with the aim to potentially delay the onset of late Fontan failure, and to possibly use larger extracardiac conduits. We retrospectively reviewed our surgical experience with Fontan operation, to understand the impact of this strategy on morbidity and mortality.
METHODS: Between 1990 and 2008, 65 patients underwent a modified Fontan operation at our institution (extracardiac conduit in 52 and lateral tunnel in 13). The median age at operation in our series was 7.3 years (range: 2.2-15.8 years) and this value was used to divide the study cohort into two groups. Group A (n=28) included patients with an age at Fontan operation <or=7 years, whereas group B (n=37) included patients who had a Fontan operation at >7 years of age. Preoperative characteristics, intra-operative data and short- and medium-term results were assessed.
RESULTS: No differences in baseline characteristics, morbidity and mortality were evident between groups. Hospital mortality was 0% in group A and 5.4% (2/37) in group B (p=0.5). Prolonged pleural effusions were present in eight patients in group A (29%) and seven in group B (19%, p=0.39). After a mean follow-up of 5.7+/-5.4 years (range: 0.3-18 years), the overall mortality of group A (1/28) was similar to that of group B (2/37) (3.6% vs 5.4%, p=0.999). The incidence of arrhythmias, protein-losing enteropathy, Fontan take down and re-operation were not different between the two groups.
CONCLUSIONS: The modified Fontan operation can be performed safely in older patients without affecting operative and medium-term follow-up results. Postponing the extracardiac Fontan operation may have the advantage of the use of a larger conduit.
Carlo Pace Napoleone; Guido Oppido; Emanuela Angeli; Alessandro Giardini; Elvira Resciniti; Gaetano Gargiulo
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-10-02
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2011-01-19     Revised Date:  2011-02-01    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  645-50     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Pediatric and Adult Congenital Cardiac Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy.
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MeSH Terms
Age Distribution
Age Factors*
Child, Preschool
Epidemiologic Methods
Fontan Procedure / adverse effects,  methods*
Heart Defects, Congenital / surgery*
Heart Ventricles / abnormalities
Pleural Effusion / etiology
Treatment Outcome
Comment In:
Eur J Cardiothorac Surg. 2011 Jan;39(1):144; author reply 144-5   [PMID:  20554215 ]

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