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Ann Thorac Surg 2004;77:889-894
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Outcomes of tricuspid atresia in the Fontan era

^a Departments of Pediatrics and Surgery, Divisions of Cardiology and Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada

Accepted for publication September 5, 2003.

^* Address reprint requests to Dr McCrindle, Division of Cardiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G-1X8, Canada
e-mail: brian.mccrindle{at}sickkids.ca

BACKGROUND: Whereas indications expand and results improve with increasing refinements to the Fontan procedure the overall impact on outcomes related to tricuspid atresia remains suboptimally defined.

METHODS: We reviewed 225 consecutive patients presenting between 1971 and 1999. All patients had classic tricuspid atresia with absent right atrioventricular connection and with D-transposition of the great arteries in 21%, pulmonary outflow obstruction in 75%, and aortic outflow obstruction in 11%.

RESULTS: Ten patients died before any intervention and 3 patients were lost to follow-up. Palliative procedures (includes 151 with systemic shunt, 27 pulmonary artery banding, 60 venous shunt) were performed in 203 patients, with 44 deaths, 8 patients awaiting Fontan, 12 patients Fontan contraindicated, and 11 patients lost-to-follow-up. A total of 137 patients had the Fontan procedure (9 patients without previous procedures) with 7 early deaths, 11 late deaths, and 3 patients progressing to heart transplantation. Total survival for the cohort was 90% at the age of 1 month, 81% at 1 year, 70% at 10 years, and 60% at 20 years with no significant change over the time period. Independent factors associated with ineligibility or death without Fontan (n = 68, 30%) included earlier birth date, lower birth weight, presence of aortic arch anomaly and greater right ventricular hypoplasia, and no palliative procedure. There were no significant changes in mortality with Fontan over the study time period with survival of 95% at 1 month, 93% at 1year, and 82% at 10 years.

CONCLUSIONS: Improvements in outcomes with tricuspid atresia will require attention to management and risk factors before Fontan.

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