Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T04:29:14.224Z Has data issue: false hasContentIssue false
  • English
  • Français

Early conversion of classic Fontan conversion may decrease term morbidity: single centre outcomes

Published online by Cambridge University Press:  28 June 2019

David Blitzer ,
Asma S. Habib ,
John W. Brown ,
Adam C. Kean Open the ORCID record for Adam C. Kean [Opens in a new window] ,
Jiuann-Huey I. Lin ,
Mark W. Turrentine ,
Mark D. Rodefeld ,
Jeremy L. Herrmann  and
William Aaron Kay
David Blitzer*
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Asma S. Habib
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
John W. Brown
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Adam C. Kean
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Jiuann-Huey I. Lin
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Mark W. Turrentine
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Mark D. Rodefeld
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
Jeremy L. Herrmann
Affiliation:
Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
William Aaron Kay
Affiliation:
Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: D. Blitzer, MD, 545 Barnhill Rd, Indianapolis, IN 46202, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The initial classic Fontan utilising a direct right atrial appendage to pulmonary artery anastomosis led to numerous complications. Adults with such complications may benefit from conversion to a total cavo-pulmonary connection, the current standard palliation for children with univentricular hearts.

Methods:

A single institution, retrospective chart review was conducted for all Fontan conversion procedures performed from July, 1999 through January, 2017. Variables analysed included age, sex, reason for Fontan conversion, age at Fontan conversion, and early mortality or heart transplant within 1 year after Fontan conversion.

Results:

A total of 41 Fontan conversion patients were identified. Average age at Fontan conversion was 24.5 ± 9.2 years. Dominant left ventricular physiology was present in 37/41 (90.2%) patients. Right-sided heart failure occurred in 39/41 (95.1%) patients and right atrial dilation was present in 33/41 (80.5%) patients. The most common causes for Fontan conversion included atrial arrhythmia in 37/41 (90.2%), NYHA class II HF or greater in 31/41 (75.6%), ventricular dysfunction in 23/41 (56.1%), and cirrhosis or fibrosis in 7/41 (17.1%) patients. Median post-surgical follow-up was 6.2 ± 4.9 years. Survival rates at 30 days, 1 year, and greater than 1-year post-Fontan conversion were 95.1, 92.7, and 87.8%, respectively. Two patients underwent heart transplant: the first within 1 year of Fontan conversion for heart failure and the second at 5.3 years for liver failure.

Conclusions:

Fontan conversion should be considered early when atrial arrhythmias become common rather than waiting for severe heart failure to ensue, and Fontan conversion can be accomplished with an acceptable risk profile.

Keywords

Classic FontanFontan conversionCHDheart failurearrhythmia
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 8 , August 2019 , pp. 1045 - 1050
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Drs Blitzer and Habib contributed equally to the preparation of this manuscript as co-first authors. Dr Blitzer accepts responsibility for the integrity of this work.

References

Sprindzuk, M. The Fontan procedure and circulation: the history, modifications, complications, and health issues. J Thorac Cardiovasc Surg 2007; 12(1).CrossRefGoogle Scholar
Mavroudis, C, Backer, C, Deal, B, et al. Evolving anatomic and electrophysiologic considerations associated with Fontan conversion. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007; 10: 136–145.CrossRefGoogle Scholar
Poh, CL, Zannino, D, Weintraub, RG, et al. Three decades later: the fate of the population of patients who underwent the Atriopulmonary Fontan procedure. Int J Cardiol 2017; 231: 99–104. doi: 10.1016/j.ijcard.2017.01.057. Epub 2017 Jan 7.CrossRefGoogle ScholarPubMed
Schilling, C, Dalziel, K, Nunn, R, et al. The Fontan epidemic: population projections from the Australia and New Zealand Fontan Registry. Int J Cardiol 2016; 219: 14–19. doi: 10.1016/j.ijcard.2016.05.035. Epub 2016 May 14.CrossRefGoogle ScholarPubMed
Mavroudis, C, Deal, B, Backer, C, et al. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes. Ann Thorac Surg 2007; 8: 1457–1466.CrossRefGoogle Scholar
Sridhar, A, Giamberti, A, Foresti, A, et al. Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre. Cardiol Young 2011; 21: 665–669.CrossRefGoogle ScholarPubMed
Brida, M, Baumgartner, H, Gatzoulis, MA, Diller, GP. Early mortality and concomitant procedures related to Fontan conversion: quantitative analysis. Int J Cardiol 2017; 236: 132–137. doi: 10.1016/j.ijcard.2017.01.111. Epub 2017 Jan 25.CrossRefGoogle ScholarPubMed
Deal, BJ, Costello, JM, Webster, G, Tsao, S, Backer, CL, Mavroudis, C. Intermediate-term outcome of 140 consecutive Fontan conversions with arrhythmia operations. Ann Thorac Surg 2016; 101: 717–724.CrossRefGoogle ScholarPubMed
Pundi, KN, Johnson, JN, Dearani, JA, et al. 40-year follow-up after the Fontan operation: long-term outcomes of 1052 patients. J Am Coll Cardiol 2015; 66: 1700–1710.CrossRefGoogle Scholar
Takahashi, K, Fynn-Thompson, F, Cecchin, F, Khairy, P, del Nido, P, Triedman, JK. Clinical outcomes of Fontan conversion surgery with and without associated arrhythmia intervention. Int J Cardiol 2009; 137: 260–266.CrossRefGoogle ScholarPubMed
Morales, DL, Dibardino, DJ, Braud, BE, et al. Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit. Ann Thorac Surg 2005; 80: 1445–1451.CrossRefGoogle ScholarPubMed
Hiramatsu, T, Iwata, Y, Matsumura, G, Konuma, T, Yamazaki, T. Impact of Fontan conversion with arrhythmia surgery and pacemaker therapy. Eur J Cardiothorac Surg 2011; 40: 1007–1010.Google ScholarPubMed
Poh, CL, Cochrane, A, Galati, JC, et al. Ten-year outcomes of Fontan conversion in Australia and New Zealand demonstrate the superiority of a strategy of early conversion dagger. Eur J Cardiothorac Surg 2016; 49: 530–535.CrossRefGoogle Scholar
Fuller, SM, He, X, Jacobs, JP, et al. Estimating mortality risk for adult congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2015; 100: 1728–1735.CrossRefGoogle ScholarPubMed
van Melle, JP, Wolff, D, Horer, J, et al Surgical options after Fontan failure. Heart 2016; 102: 1127–1133.CrossRefGoogle ScholarPubMed
Wilson, TG, Iyengar, AJ, Winlaw, DS, et al. Use of ACE inhibitors in Fontan: rational or irrational?; Australia and New Zealand Fontan registry. Int J Cardiol 2016; 210: 95–99. doi: 10.1016/j.ijcard.2016.02.089. Epub 2016 Feb 18.CrossRefGoogle ScholarPubMed
Deal, BJ, Costello, JM, Webster, G, Tsao, S, Backer, CL, Mavroudis, C. Intermediate-term outcome of 140 consecutive Fontan conversions with arrhythmia operations. Ann Thorac Surg 2016; 101: 717–724. doi: 10.1016/j.athoracsur.2015.09.017. Epub 2015 Nov 18.CrossRefGoogle ScholarPubMed
Backer, CL, Russell, HM, Pahl, E, et al. Heart transplantation for the failing Fontan. Ann Thorac Surg 2013; 96: 1413–1419. doi: 10.1016/j.athoracsur.2013.05.087. Epub 2013 Aug 27.CrossRefGoogle ScholarPubMed