Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T23:12:25.941Z Has data issue: false hasContentIssue false
  • English
  • Français

Permanent pacing post-Fontan is not associated with reduced long-term survival

Published online by Cambridge University Press:  11 October 2019

Sally J. Hall Open the ORCID record for Sally J. Hall [Opens in a new window] ,
Damien Cullington ,
John D. R. Thomson  and
James R. Bentham
Sally J. Hall
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
Damien Cullington
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
John D. R. Thomson
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
James R. Bentham*
Affiliation:
Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
*
Author for correspondence: Dr J. Bentham, Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK. Tel: +44 (0) 1133928239; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The Fontan procedure is the final stage of surgical palliation for a single-ventricle circulation. Significant complications are common including rhythm disturbance necessitating implantation of a permanent pacemaker. This has been widely considered a negative prognostic indicator.

Methods:

This single-centre, retrospective case control study involved all patients who underwent the Fontan procedure at the Leeds Congenital Heart Unit between 1990 and 2015 and have had regular follow-up in Yorkshire and Humber, United Kingdom. 167 Fontan patients were identified of which 2 were excluded for having a pre-procedure pacemaker. Of the remainder, 23 patients required a pacemaker. Outcomes were survival, early and late complications, need for further intervention and oxygen saturation in long-term follow-up.

Results:

There was no difference in survival (30-day survival pacemaker 92.6%, sinus rhythm 90.5%, p = 0.66, 1-year pacemaker 11.1%, sinus rhythm 10.1%, p = 1). The pacemaker group was more likely to have cerebral or renal complications in the first-year post-procedure (acute kidney injury: sinus rhythm 0.8%, pacemaker 19.1%, p = 0.002). No difference was observed in longer term complications including protein losing enteropathy (sinus rhythm 3.5%, pacemaker 0% p = 1). There was no difference in saturations between the two groups at follow-up. Paced patients were more likely to have required further intervention, with a higher incidence of cardiopulmonary bypass procedures (sinus rhythm 6.3%, pacemaker 35%, p < 0.001).

Conclusions:

Despite an increase in early complications and the need for further interventions, pacemaker requirement does not appear to affect long-term survival following the Fontan procedure.

Keywords

Congenital heart diseaseFontan procedurepacemaker
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1432 - 1434
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.)

References

McGuirk, SP, Griselli, M, Stumper, OF, et al. Staged surgical management of hypoplastic left heart sundrome: a single institution 12 year experience. Heart 2006; 92: 364–370.CrossRefGoogle Scholar
Bando, Ko, Turrentine, MW, Sun, K, et al. Surgical management of hypoplastic left heart syndrome. Ann Thorac Surg 1996; 62: 70–76.CrossRefGoogle ScholarPubMed
Pundi, KN, Johnson, JN, Dearani, JA, et al. 40-year follow-up after the Fontan operation. Am J Cardiol 2015; 66: 1700–1710.CrossRefGoogle ScholarPubMed
Pigott, JD, Norwood, WI. The Fontan procedure. Curr Opin Cardiol 1989; 4: 286–290.CrossRefGoogle Scholar
Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
Anderson, PAW, Sleeper, LA, Mahony, L, et al. Pediatric heart network investigators. Contemporary outcomes after the Fontan procedure. Am J Cardiol 2008; 52: 85–98.CrossRefGoogle ScholarPubMed
John, AS, Johnson, JA, Khan, M, et al. Clinical outcomes and improved survival in patients with protein-losing enteropathy after the Fontan operation. Am J Cardiol 2014; 64: 54–62.CrossRefGoogle ScholarPubMed
Franken, LC, Admiraal, M, Verrall, CE, et al. Improved long-term outcomes in double-inlet left ventricle and tricuspid atresia with transposed great arteries: systemic outflow tract obstruction present at birth defines long-term outcome. Eur J Cardiothorac Surg 2017; 51: 1051–1057.CrossRefGoogle ScholarPubMed