Outcome after Fontan Operation in Korea.
- Author:
Soo Jin KIM
1
;
Hong Gook LIM
;
So Ik JANG
;
Sung Hae KIM
;
Jae Young LEE
;
Woo Sup SHIM
;
Chul LEE
;
Chang Ha LEE
;
Woong Han KIM
Author Information
1. Department of Pediatrics, Sejong General Hospital and Sejong Heart Institute., Korea.
- Publication Type:Note
- Keywords:
Extracardiac conduit;
Fontan operation
- MeSH:
Arrhythmias, Cardiac;
Arterial Pressure;
Follow-Up Studies;
Fontan Procedure*;
Freedom;
Heart;
Heart Bypass, Right;
Heterotaxy Syndrome;
Hospital Mortality;
Humans;
Incidence;
Korea*;
Longevity;
Mortality;
Multivariate Analysis;
Postoperative Period;
Preoperative Period;
Reoperation;
Risk Factors;
Survivors;
Thromboembolism
- From:Journal of the Korean Pediatric Cardiology Society
2007;11(1):34-43
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Despite extracardiac conduit Fontan had many advantages, long-term results related to longevity of conduit, and anticoagulation were not proven. This study was to evaluate the long-term outcome of hospital survivors with extracardiac Fontan circulation. METHODS: Between 1996 and 2006, 200 patients underwent extracardiac conduit Fontan operation. Median age at the Fontan operation was 3.4 years (range:16 months-35.7 years). All patients (89.5 %) except 21 patients of one stage Fontan operation underwent bi-directional cavopulmonary shunt. Fenestration was required in 85 patients (42.5%). RESULTS: There has been 6 hospital mortalities (3.0%), and 7 late mortalities (3.6%) at a mean follow-up of 52.4+/-32.2 months (range; 18days-120 months). Overall 10-years survival was 92.4 2.1%. Multivariate analysis identified severe infection at early postoperative periods (hazard ratio =12.439, P=0.001), and high pulmonary arterial pressure at preoperative period (hazard ratio=3.445, P=0.038) as risk factors for mortality. Reoperation was performed in 24 patients (12.0%), and freedom from reoperation was 82.4+/-4.1% at 10 years. Arrhythmia occurred in 32 patients (16.0%) after Fontan operation, and freedom from arrhythmia was 85.14.4% at 10 years. Risk factors for arrhythmia were heterotaxy syndrome (P=0.001), Follow up duration (P=0.027) and the age at Fontan operation (P=0.001). Freedom from thromboembolism was 92.91.9% at 10 years. The conduit cross- sectional area decreased by 14%, and the extent of decrease of the conduit cross-sectional remained stable irrespective of the follow-up duration. 95.2% of patients had New York Heart Association class I. CONCLUSIONS: After 10 years of follow-up, the overall survival, and the functional status of survivors of the extracardiac Fontan procedure are satisfactory. Fenestration has a beneficial effect on the results of high-risk Fontan patients. The incidence of late deaths, reoperations, obstructions of the cavopulmonary pathway, arrhythmias and thromboembolisms is low.
