Factors influencing early and late outcome following the Fontan procedure in the current era.: The ‘Two Commandments’?

Hosein, Riad B.M.; Clarke, Andrew J.B.; McGuirk, Simon P.; Griselli, Massimo; Stumper, Oliver; De Giovanni, Joseph V.; Barron, David J.; Brawn, William J.
March 2007
European Journal of Cardio-Thoracic Surgery;Mar2007, Vol. 31 Issue 3, p344
Academic Journal
Abstract: Objective: This study was undertaken to identify the factors affecting early and late outcome following the Fontan procedure in the current era. We have examined whether conventional selection criteria, the ‘Ten Commandments’, are still applicable in the current era. Materials and methods: Between January 1988 and July 2004, 406 patients underwent a modified Fontan procedure at a median age of 4.7 years (IQR, 3.8–7.1 years). The single functional ventricle was of left (n =241, 59%) or right ventricular morphology (n =163, 40%). The modified Fontan procedure was performed using an atriopulmonary connection (n =162, 40%) or total cavopulmonary connection (TCPC) involving a lateral atrial tunnel (n =50, 12%) or extracardiac conduit (n =194, 48%). They were fenestrated in 216 patients (53%). Results: The early mortality was 4.4% (n =18) and four other patients required takedown of the Fontan circulation. On multivariable analysis, early outcome was adversely influenced by two factors (p <0.05): preoperative impaired ventricular function and elevated pulmonary artery pressures. Two risk models were constructed for early outcome based on preoperative and predictable operative variables (Model 1) and all preoperative and operative data (Model 2). Both models were calibrated across all deciles (p =0.83, p =0.25) and discriminated well. The area under the ROC curve was 0.85 and 0.89, respectively. There were 21 late deaths, 1 patient required late takedown of the Fontan circulation and 3 required orthotopic cardiac transplantation. Actuarial survival was 90±2%, 86±2% and 82±3% at 5, 10 and 15 years, respectively. Multivariable analysis identified that outcome was influenced by preoperatively impaired ventricular function, elevated preoperative pulmonary artery pressures and an earlier year of operation. The freedom from reintervention was 83±4%, 76±4% and 74±8% at 5, 10 and 15 years, respectively. Additional risk factors for reintervention were right atrial isomerism and preoperative small pulmonary artery size. Conclusions: Late outcome of the Fontan circulation is encouraging. Ventricular morphology, surgical technique and fenestration do not appear to influence early or late outcome. Preoperatively impaired ventricular function and elevated pulmonary artery pressures have an adverse influence on both early and late outcome. Reintervention is common, with small preoperative pulmonary artery size being an additional risk factor.


Related Articles

  • Comparison of hemodynamics between Norwood procedure and systemic-to-pulmonary artery shunt for single right ventricle patients. Takabayashi, Shin; Kado, Hideaki; Shiokawa, Yuichi; Fukae, Kouji; Nakano, Toshihide // European Journal of Cardio-Thoracic Surgery;Jun2005, Vol. 27 Issue 6, p968 

    Abstract: Objective: Despite that surgical outcomes of patients with hypoplastic left heart syndrome have improved, one of the problems remaining is the high interstage mortality after a stage I Norwood procedure. The purpose of this study was to determine the hemodynamic characteristics of...

  • latrogenic pulmonary artery pseudoaneurysm: images from different modalities. McQueen, A. S.; Mitchell, I.; Muller, M.; MacGowan, G.; Corris, P. // Thorax;Oct2008, Vol. 63 Issue 10, p936 

    The article presents a pulmonary artery hypertension examination conducted to a 68-year-old woman. To investigate the cause of this disease, a CT pulmonary angiogram, a cardiac MRI, and a catheter angiogram were performed, its images are showed. It infers that most ruptures of the right...

  • ANOMALOUS ORIGIN OF LEFT PULMONARY ARTERY FROM THE ASCENDING AORTA. Schiller, Medad; Williams Jr., Thomas E.; Craenen, Josepha; Hosier, Don M.; Sirak, Howard D. // Vascular Surgery;May/Jun1971, Vol. 5 Issue 3, p126 

    A patient whose left pulmonary artery arose from the ascending aorta is described. The embryology and a review of the literature concerning this unusual anomaly is presented. This is the third reported case of an anomalous origin of the left pulmonary artery without associated intracardiac...

  • The bronchopulmonary foregut malformation complex. Freedom, Robert M.; Shi-Joon Yoo; Hyun Woo Goo; Mikailian, Haverj; Anderson, Robert H. // Cardiology in the Young;Jun2006, Vol. 16 Issue 3, p229 

    The article describes the terminology of pulmonary sequestration. Pulmonary sequestration is used to describe a segment of lung that does not have any identifiable connection with the normal tracheobronchial tree, and which receives its arterial supply from one or more systemic arteries, rather...

  • THE LARGE PULMONARY ARTERY. Liu, C. K.; Jona, E.; Haring, O. M. // Angiology;Apr1958, Vol. 9 Issue 2, p67 

    The finding of large pulmonary artery includes a large number of different diseases. A classification based upon the presence or absence of primary changes in pulmonary hemodynamics is discussed. Eight selected cases are presented and briefly discussed.

  • Successful staged repair for a rare type of truncus arteriosus with interruption of the aortic arch and abnormal origin of the left coronary artery. Uchita, Shunji; Harada, Yorikazu; Honda, Kentaro; Toguchi, Koji; Nishimura, Yoshiharu; Suenaga, Tomohiro; Takeuchi, Takashi; Suzuki, Hiroyuki; Okamura, Yoshitaka // Journal of Cardiothoracic Surgery;2013, Vol. 8 Issue 1, p1 

    We report a successful staged repair for a quite rare combination of truncus arteriosus (TA), Van Praagh type A4, and abnormal origin of the left coronary artery (CA). Furthermore, the case was complicated by a variant of the chromosomal anomaly in cat-cry syndrome. The presence of interruption...

  • Architecture must document functional evidence to explain the living rhythm Buckberg, Gerald D. // European Journal of Cardio-Thoracic Surgery;Feb2005, Vol. 27 Issue 2, p202 

    Summary: The central theme of surgical procedures is to interact structure and function. Two reviews of architecture by Torrent-Guasp and Lunkenheimer provide anatomic observations, and then only deduce, rather than test and verify functional relationships. Lunkenheimer previously showed the...

  • Rhythmical contractions in pulmonary arteries of monocrotaline-induced pulmonary hypertensive rats. Kiyoshi, Akihiko; Ishikawa, Tomohisa; Hayashi, Ken-ichi; Iwatsuki, Yoshiyuki; Ishii, Kunio; Nakayama, Koichi // Pflugers Archiv European Journal of Physiology;Nov2003, Vol. 447 Issue 2, p142 

    Rhythmical contractions accompanied by an increase in cytosolic Ca2+ concentrations were produced in ring preparations of endothelium-denuded pulmonary arteries from monocrotaline-treated rats, but not in those from vehicle-treated rats, 2–3 h after a resting tension of 15 mN...

  • Right pulmonary artery torsion following surgical reimplantation. Martinez, Patricia; Déry, Julie; Vobecky, Suzanne; Bigras, Jean-Luc; Lapierre, Chantale // Pediatric Radiology;Dec2012, Vol. 42 Issue 12, p1514 

    We report the case of a 3-month-old boy with an anomalous origin of right pulmonary artery (AORPA) from the ascending aorta who presented postoperatively with torsion of the right pulmonary artery demonstrated on 3-D volume-rendered CT angiogram. To our knowledge, CT images of this entity have...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics