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

45 Citations (Scopus)

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)
JournalCirculation
Volume96
Issue number9 SUPPL.
StatePublished - Nov 4 1997
Externally publishedYes

Fingerprint

Fontan Procedure
Chest Tubes
Venae Cavae
Ventricular Function
Mortality
Artificial Respiration
Drainage
Oxygen
Morbidity

Keywords

  • Congenital
  • Fontan procedure
  • Heart defects
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

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.).

Outcome after the single-stage, nonfenestrated Fontan procedure. / Hsu, Daphne T.; Quaegebeur, Jan M.; Ing, Frank F.; Selber, Evelyn J.; Lamour, Jacqueline M.; Gersony, Welton M.

In: Circulation, Vol. 96, No. 9 SUPPL., 04.11.1997.

Research output: Contribution to journalArticle

Hsu, DT, Quaegebeur, JM, Ing, FF, Selber, EJ, Lamour, JM & Gersony, WM 1997, 'Outcome after the single-stage, nonfenestrated Fontan procedure', Circulation, vol. 96, no. 9 SUPPL..
Hsu DT, Quaegebeur JM, Ing FF, Selber EJ, Lamour JM, Gersony WM. Outcome after the single-stage, nonfenestrated Fontan procedure. Circulation. 1997 Nov 4;96(9 SUPPL.).
Hsu, Daphne T. ; Quaegebeur, Jan M. ; Ing, Frank F. ; Selber, Evelyn J. ; Lamour, Jacqueline M. ; Gersony, Welton M. / Outcome after the single-stage, nonfenestrated Fontan procedure. In: Circulation. 1997 ; Vol. 96, No. 9 SUPPL.
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AU - Hsu, Daphne T.

AU - Quaegebeur, Jan M.

AU - Ing, Frank F.

AU - Selber, Evelyn J.

AU - Lamour, Jacqueline M.

AU - Gersony, Welton M.

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AB - 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.

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KW - Heart defects

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