ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;88:1291-1299. doi:10.1016/j.athoracsur.2009.05.076
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
James S. Tweddell
Kathleen A. Mussatto
Michael E. Mitchell
Nancy S. Ghanayem
Rammohan Marla
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Tweddell, J. S.
Right arrow Articles by Hoffman, G. M.
PubMed
Right arrow Articles by Tweddell, J. S.
Right arrow Articles by Hoffman, G. M.
Related Collections
Right arrow Congenital - cyanotic

Original Articles: Pediatric Cardiac

Fontan Palliation in the Modern Era: Factors Impacting Mortality and Morbidity

James S. Tweddell, MD*, Matthew Nersesian, BS, Kathleen A. Mussatto, PhD, RN, Melodee Nugent, MA, Pippa Simpson, PhD, Michael E. Mitchell, MD, Nancy S. Ghanayem, MD, Andrew N. Pelech, MD, Rammohan Marla, MD, George M. Hoffman, MD

Division of Cardiothoracic Surgery, Department of Surgery, Sections of Pediatric Cardiology and Critical Care, Departments of Pediatrics and Quantitative Health Sciences, Medical College of Wisconsin and Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Accepted for publication May 21, 2009.

* Address correspondence to Dr Tweddell, MS 715, Children's Hospital of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI 53226 (Email: jtweddell{at}chw.org).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Advances in management of the Fontan patient include interval superior cavopulmonary shunt, total cavopulmonary connection, either lateral tunnel or extracardiac conduit, and the use of a fenestration. Coincident with these improvements, Fontan palliation has been applied to a wider ranger of anatomic subgroups.

Methods: A cross-sectional analysis of 256 consecutive patients undergoing a total cavopulmonary connection Fontan after superior cavopulmonary shunt between January 1, 1994, and June 30, 2007 were studied. Fenestration was used selectively. Fontan failure was defined as death, transplant, or takedown. Event-free survival was defined as freedom from death, transplant, Fontan takedown, functional class III to IV, pacemaker, antiarrhythmic medication, protein-losing enteropathy, stroke, or thrombus.

Results: Survival was 97% ± 1%, 96% ± 1%, and 94% ± 2%, respectively, at 1, 5, and 10 years. Event-free survival was 96% ± 1%, 87% ± 3%, and 64% ± 6%, respectively, at 1, 5, and 10 years. Factors predicting worse event-free survival included longer cross-clamp time (p = 0.003), fenestration (p = 0.014), and longer hospital length of stay (p = 0.016). Ventricular morphology did not predict outcome. Left ventricle (n = 113, 44%) versus right ventricle (n = 142, 56%) failure-free survival (death, transplant, or Fontan takedown) at 10 years was 92% ± 4% versus 91% ± 3%, respectively (p = 0.19). Left ventricle versus right ventricle event-free survival at 10 years was 75% ± 7% versus 67% ± 9%, respectively (p > 0.1).

Conclusions: Survival for patients undergoing a completion Fontan in the current era is excellent, but patients remain at risk for morbid events. In the intermediate follow-up period, we could not identify a difference in outcome between dominant left and right ventricle morphology.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The Society of Thoracic Surgeons.