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Ann Thorac Surg 1989;48:654-659
© 1989 The Society of Thoracic Surgeons

Articles

Prevalence of reoperation for pathway obstruction after Fontan operation

Guy Fernandez, MDa,b, Francisco Costa, MDa,b,1, Francis Fontan, MD*,a,b, David C. Naftel, PhDa,b, Eugene H. Blackstone, MDa,b, John W. Kirklin, MDa,b

a Department of Cardiovascular Surgery, The Surgical Clinic for Cardiac Diseases, Hôpital Cardiologique du Haut-Leveque, Bordeaux, France
b Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham Medical Center, Birmingham, Alabama UK

Accepted for publication July 25, 1989.

* Address reprint requests to Dr Fontan, Hôpital Cardiologique du Haut-Leveque, University of Bordeaux, Avenue de Magellan, 33604 Pessac, Bordeaux, France.

Among 334 patients undergoing the Fontan operation at two institutions and followed for a long time, freedom from reoperation for Fontan pathway obstruction was 99% at 1 year after operation and 96%, 86%, and 59%, respectively, at 5, 10, and 15 years after operation. The hazard function for reoperation had an initial very rapidly declining phase and a second phase that was still rising 15 years after operation. Twelve (17%; confidence limits [CL], 13% to 23%) of 69 patients with a right atrial to right ventricular conduit (valved or nonvalved) connection underwent reoperation for pathway obstruction, whereas only 2 (4%; CL, 1% to 10%) of 45 patients with a direct connection to the right ventricle required reoperation. Five (8%; CL, 4% to 13%) of 65 patients with a right atrial to pulmonary artery conduit connection required reoperation for pathway obstruction, and only 2 (1.3%; CL, 0.4% to 3%) of 155 patients with a direct right atrial to pulmonary artery connection required reoperation. These findings have implications as to the optimal technique of the Fontan operation and also as to use of an intraatrial tunnel as part of the repair.




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