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Ann Thorac Surg 1994;57:170-176
© 1994 The Society of Thoracic Surgeons

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Articles

Early and intermediate results of the fontan procedure at moderately high altitude

Divisions of Pediatric Cardiology and Cardiothoracic Surgery, Primary Children's Medical Center, Salt Laka City, Utah, USA

Accepted for publication March 12, 1993.

^_* Address reprint requests to Dr Day, Division of Pediatric Cardiology, University of Utah, Primary Children's Medical Center, 100 North Medical Dr, Salt Lake City, UT 84113.

At higher elevations, alveolar hypoxia increases pulmonary vascular resistance and may limit the cardiac output of individuals without a subpulmonary ventricle. Thus, we reviewed the outcome of definitive palliation for tricuspid atresia and other forms of single ventricle in 60 consecutive Fontan patients living at a mean elevation of 1,370 m (range, 910 to 2,130 m). There were four early deaths (6.7%; 70% confidence limits, 4.1% to 10.7%) and six late deaths. Kaplan-Meier actuarial survival (± standard error) is 79.6% ± 8.2% at 5 years. Survival was significantly decreased in patients with a preoperative mean pulmonary arterial pressure greater than or equal to 15 mm Hg unless the Fontan procedure was performed with a residual fenestrarion. Exercise tolerance was significantly worse at higher elevations in a subgroup of patients who have traveled to altitudes of 1,680 to 3,350 m. We conclude that the early and intermediate results of the Fontan procedure at moderately high altitude are similar to results reported at sea level. However, exercise tolerance may be impaired at higher elevations in many patients.

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