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

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Original Articles: Cardiovascular

Outcome After Fontan Failure and Takedown to an Intermediate Palliative Circulation

^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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