HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Amram J. Cohen David C. Cleveland George A. Trusler John G. Coles Ivan M. Rebeyka William G. Williams Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cohen, A. J. Articles by Williams, W. G. Search for Related Content PubMed PubMed Citation Articles by Cohen, A. J. Articles by Williams, W. G.

Ann Thorac Surg 1991;52:1266-1271
© 1991 The Society of Thoracic Surgeons

---

Articles

Results of the Fontan procedure for patients with univentricular heart

Departments of Cardiovascular Surgery and Cardiology, The Hospital for Sick Children, Toronto, Canada

^_* Address reprint requests to Dr Cohen, Department of Thoracic Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001 USA.

One hundred twenty-four consecutive patients with univentricular heart undergoing the Fontan operation were reviewed. Patients with tricuspid atresia or biventricular heart with hypoplasia of one ventricle were excluded. Eighty-four patients had left ventricular morphology. Atrioventricular connection was double-inlet (n = 76), common (n = 29), absent left atrioventricular connection (n = 14), and absent right atrioventricular connection (n = 5). Actuarial survival was 77% (70% confidence limits, 73% to 81%) at 1 year, 66% (70% confidence limits, 60% to 72%) at 5 years, and 49% (70% confidence limits, 36% to 61%) at 10 years, indicating a continuing risk for premature death. Multivariate analysis identified preoperative ventricular function and hypertrophy as risk factors for survival. High postrepair right atrial pressure (>15 mm Hg) emerged as a strong intraoperative predictor of survival. Logistic regression analysis of these factors predicts high probability of death for certain subgroups of patients after the Fontan operation. Forty-four percent (n = 53) of these original 124 patients are alive and in New York Heart Association class I at follow-up. Thirty-eight percent (n = 33) of survivors have worse ventricular function than preoperative. Long-term survival is disappointing. Certain identifiable subgroups of patients with univentricular heart have unacceptable risks for the Fontan operation and should have alternate management. High postrepair right atrial pressure is an ominous sign, and if it persists the Fontan should be fenestrated or taken down.

This article has been cited by other articles:

				M. A. Binotto, M. d. L. Higuchi, and V. D. Aiello Left ventricular remodeling in hearts with tricuspid atresia: morphologic observations and possible basis for ventricular dysfunction after surgery J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1026 - 1032. [Abstract] [Full Text] [PDF]

				S. Khambadkone, J. Li, M.R. de Leval, S. Cullen, J.E. Deanfield, and A.N. Redington Basal Pulmonary Vascular Resistance and Nitric Oxide Responsiveness Late After Fontan-Type Operation Circulation, July 1, 2003; 107(25): 3204 - 3208. [Abstract] [Full Text] [PDF]

				R. M. Freedom and G. S. Van Arsdell Biventricular hearts not amenable to biventricular repair Ann. Thorac. Surg., August 1, 1998; 66(2): 641 - 643. [Abstract] [Full Text] [PDF]

				R. M. Freedom Subaortic obstruction and the fontan operation Ann. Thorac. Surg., August 1, 1998; 66(2): 649 - 652. [Abstract] [Full Text] [PDF]

				D. M. Cohen Surgical Management of Congenital Heart Disease in the 1990s Arch Pediatr Adolesc Med, December 1, 1992; 146(12): 1447 - 1452. [Abstract] [PDF]