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Ann Thorac Surg 2007;84:880-887
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Outcome After Fontan Failure and Takedown to an Intermediate Palliative Circulation

Christopher S.D. Almond, MD, MPHa,c, John E. Mayer, Jr, MDb,d, Ravi R. Thiagarajan, MDa, Elizabeth D. Blume, MDa, Pedro J. del Nido, MDb,d, Doff B. McElhinney, MDa,c,*

a Department of Cardiology, Children’s Hospital, Boston, Massachusetts
b Department of Cardiac Surgery, Children’s Hospital, Boston, Massachusetts
a Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
b Department of Surgery, Harvard Medical School, Boston, Massachusetts

Accepted for publication February 28, 2007.

* Address correspondence to Dr McElhinney, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (Email: doff.mcelhinney{at}cardio.chboston.org).

Background: Fontan takedown to an intermediate palliative circulation is an important treatment option for patients with acute or subacute failure of a Fontan circulation from a variety of causes. Little is known about the subsequent outcome of these patients or their potential candidacy for a second attempt at Fontan completion.

Methods: Patients followed up at Children’s Hospital Boston who underwent takedown of a Fontan circulation to an intermediate palliative circulation within 1 year of Fontan completion were reviewed.

Results: Between 1979 and 2006, 53 patients underwent Fontan takedown at a median age of 2.3 years (range, 0.3 to 36.5 years). Takedown was performed during the Fontan procedure itself in 12 patients (22%), within the first postoperative month in 31(58%), and between 1 month and 1 year in 10 (18%). Overall, 29 patients (55%) survived the early period after takedown, and 19 ultimately underwent successful Fontan completion a median of 4.6 years after takedown; all but one was alive a median of 6.4 years later. Thirteen (68%) of the 19 had treatable abnormalities contributing to Fontan failure.

Conclusions: Fontan takedown can provide effective stabilization of the acutely or subacutely failing Fontan circulation, although a substantial number of patients die early despite Fontan takedown. Subjects surviving the perioperative period can often undergo uneventful redo Fontan. A thorough evaluation for treatable abnormalities should be performed in all patients with a failing Fontan circulation and in patients who undergo Fontan takedown.






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