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Ann Thorac Surg 2007;84:1457-1466. doi:10.1016/j.athoracsur.2007.06.079
© 2007 The Society of Thoracic Surgeons
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Constantine Mavroudis
Carl L. Backer
Robert D. Stewart
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Right arrow Congenital - cyanotic
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J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery

111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes

Constantine Mavroudis, MDa,c,*, Barbara J. Deal, MDb,d, Carl L. Backer, MDa,c, Robert D. Stewart, MD, MPHa,c, Wayne H. Franklin, MDb,d, Sabrina Tsao, MDb,d, Kendra M. Ward, MDb,d, R. Andrew DeFreitas, MDb,d

a Division of Cardiovascular Thoracic Surgery, Children’s Memorial Hospital, Northwestern University, Chicago Illinois
b Division of Cardiology, Children’s Memorial Hospital, Northwestern University, Chicago Illinois
c Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois
d Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago Illinois

Accepted for publication June 26, 2007.

* Address correspondence to Dr Mavroudis, Division of Cardiovascular Thoracic Surgery, M/C #22, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614. (Email: cmavroudis{at}childrensmemorial.org).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

Background: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome.

Methods: Since 1994, 111 patients (mean age 22.5 ± 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III).

Results: There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 ± 12.1 days. Mean cross-clamp time was 70.8 ± 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3).

Conclusions: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.




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