Outcome after the single-stage, nonfenestrated Fontan procedure

Daphne T. Hsu, Jan M. Quaegebeur, Frank F. Ing, Evelyn J. Selber, Jacqueline M. Lamour, Welton M. Gersony

Research output: Contribution to journalArticle

47 Scopus citations

Abstract

Background: A completed Fontan circulation is the goal in the management of patients with single-ventricle physiology. To achieve this end, a two- stage rather than a single-stage approach is carried out routinely at many centers. Some groups have advocated baffle fenestration for virtually all patients to minimize post-Fontan complications. Other centers perform single- stage Fontan operations and do not fenestrate. Thus controversies have arisen regarding the indications for the staged procedure versus single stage and for fenestration versus no fenestration. Methods and Results: The preoperative risk factors and postoperative course were characterized in 61 consecutive patients (median age, 3.3 years) undergoing a single-stage, nonfenestrated Fontan. The patients were followed for 3.5±1.9 years. The relationship between preoperative risk factors and mortality and morbidity was assessed. Preoperative risk factors assessed included age <2 years (n=18), branch pulmonary artery stenosis (n=20), elevated mean pulmonary artery pressure >15 mm Hg (n=16), atrioventricular valve regurgitation (n=5), and decreased ventricular function (n=2). Total caval pulmonary anastomosis was performed in 53 patients. Additional surgery was required at the time of the Fontan in 25 patients (41%). The median duration of mechanical ventilation was 1 day; median chest tube drainage was 5.5 days (range, 1 to 35). Oxygen saturation rose significantly postoperatively, from 83% to 95%. Early mortality was 4.9%; one patient died from pacemaker failure 9 months postoperatively, and one patient underwent successful heart transplant 4 months post-Fontan. One- and 5-year actuarial survival was 93%. No preoperative risk factor was associated with a failed Fontan or significant effusions. Conclusions: A single-stage, nonfenestrated Fontan was performed in a large group of patients with excellent surgical results and intermediate outcome. There is no evidence that a two-stage approach and/or baffle fenestration is required for a large cohort of patients who are candidates for a Fontan operation.

Original languageEnglish (US)
Pages (from-to)II335-II340
JournalCirculation
Volume96
Issue number9 SUPPL.
StatePublished - Nov 4 1997
Externally publishedYes

Keywords

  • Congenital
  • Fontan procedure
  • Heart defects
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Hsu, D. T., Quaegebeur, J. M., Ing, F. F., Selber, E. J., Lamour, J. M., & Gersony, W. M. (1997). Outcome after the single-stage, nonfenestrated Fontan procedure. Circulation, 96(9 SUPPL.), II335-II340.