Surgical options after Fontan failure
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Multicenter Study, Observational Study
PubMed
27076374
DOI
10.1136/heartjnl-2015-309235
PII: heartjnl-2015-309235
Knihovny.cz E-resources
- MeSH
- Time Factors MeSH
- Child MeSH
- Adult MeSH
- Fontan Procedure adverse effects mortality MeSH
- Kaplan-Meier Estimate MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Treatment Failure MeSH
- Postoperative Complications diagnosis mortality physiopathology surgery MeSH
- Child, Preschool MeSH
- Proportional Hazards Models MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Heart Transplantation * adverse effects mortality MeSH
- Heart Defects, Congenital diagnosis mortality surgery MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Europe MeSH
OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04). CONCLUSIONS: Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.
Children's Heart Centre The Queen Silvia Children's Hospital Gothenburg Sweden
Clinic for Cardiovascular Surgery University Hospital Zurich Zurich Switzerland
Department of Cardiac Surgery Catholic University Leuven Leuven Belgium
Department of Cardio Thoracic Surgery University Hospital of Copenhagen Copenhagen Denmark
Department of Cardiothoracic Surgery Hospital de Santa Marta Lisbon Portugal
Department of Congenital and Paediatric Cardiac Surgery and Cardiology Riuniti Hospital Ancona Italy
Department of Congenital Heart Disease Centre Chirurgical Marie Lannelongue Paris France
Division of Cardiac Surgery Cliniques Universitaires Saint Luc Brussels Belgium
German Pediatric Heart Centre Asklepios Clinic Sankt Augustin Sankt Augustin Germany
Hospital for Children and Adolescents University of Helsinki Helsinki Finland
National Heart Hospital Sofia Sofia Bulgaria
Technical University German Heart Center Munich Munich Germany
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