Abstract 2632: The Fontan Procedure: Contemporary Techniques Have Improved Long-Term Outcomes.
Objectives. To determine whether patients undergoing the lateral tunnel and extra-cardiac conduit modifications of the Fontan procedure have better outcomes than patients undergoing a classical atrio-pulmonary connection.
Methods and results. Between 1980 and 2000, 305 consecutive pts underwent a Fontan procedure at our institution. There were 10 hospital deaths for an overall mortality of 3.2%. No death occurred after 1990. Independent risk factors of mortality were pre-operative elevated pulmonary artery pressures (p=0.002) and common atrio-ventricular valve (p=0.04). Fontan was taken down during hospital stay in 7 pts. A mean of 12±6 years of follow-up was obtained in the 257 non-foreign Fontan survivors. Completeness of concurrent follow-up was 96%. Twenty-year survival was 85±3%. Recent techniques improved late survival (15-year survival after classical Fontan 81±4% vs 94±4% for lateral tunnel, p=0.004). Nine pts required heart transplantation. Freedom from supra-ventricular tachycardia (SVT) was 43±9% at 20 years. Undergoing a Fontan modification independently predicted decreased occurrence of arrhythmia (15-year freedom of SVT 61±5% for atrio-pulmonary connection vs 87±4% for lateral tunnel, p=0.02, fig 1⇓). The freedom from Fontan failure (death, take-down, transplantation or NYHA class III-IV) was 70±5% at 20 years.
Conclusion. The Fontan procedure remains a palliation, but perspectives of patients have improved. Better patient selection minimizes hospital mortality. Patients with the lateral tunnel and extra-cardiac conduit variations of the Fontan suffer less arrhythmia and are likely to have the failure of their Fontan circulation postponed.