Surgical and Catheter-Based Reinterventions Are Common in Long-Term Survivors of the Fontan Operation. (September 2017)

• Record Type: Journal Article
• Authors: Downing, Tacy E.; Allen, Kiona Y.; Goldberg, David J.; Rogers, Lindsay S.; Ravishankar, Chitra; Rychik, Jack; Fuller, Stephanie; Montenegro, Lisa M.; Steven, James M.; Gillespie, Matthew J.; Rome, Jonathan J.; Spray, Thomas L.; Nicolson, Susan C.; Gaynor, J. William; Glatz, Andrew C.
• Is Part Of: Circulation. Volume 10:Number 9(2017)
• Publication Date: 2017-09
• Subjects: catheterization -- cyanosis -- Fontan procedure -- hypoplastic left heart syndrome -- mortality -- tricuspid atresia; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.116.004924
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Background—: There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. Methods and Results—: All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9.8 years. Freedom from reoperation was 69% at 15 years and 63% at 20 years. The most common operations were pacemaker placement and Fontan revision. Risk factors for pacemaker placement included systemic left ventricle (hazard ratio [HR], 2.2; P =0.006) and lateral tunnel Fontan (HR, 4.3; P =0.001). Freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. The most common procedures performed were fenestration closure and pulmonary artery intervention. Catheter intervention for anatomic indications was associated with Fontan after 2002 (HR, 2.1; P =0.007), Norwood operation (HR, 2.3; P =0.001), and longer cardiopulmonary bypass time (HR, 1.1 per 10 minutes; P =0.001). Catheter intervention for physiological indications was associated with prolonged post-Fontan pleural drainage (HR, 4.0; P <0.001) and hypoplastic left heart syndrome (HR, 2.0; P =0.01). Conclusions—: In this study of Fontan survivors, two thirds of patients required surgical or catheter-based reintervention by 20 years. Families should be counseled that the Fontan is typically not the final stage of single-ventricle palliation. Abstract : Supplemental Digital Content is available in the text.