Abstract 12220: Ten, 20, and 30-Year Outcomes of Patients After Fontan Operation
Background: The number of adult patients undergoing the Fontan operation has been increasing annually. While more than 30 years have elapsed since surgery in some cases, clinical symptoms and quality of life in the very long-term period have not yet been assessed.
Objective: To clarify clinical symptoms and quality of life in patients in the very long-term period after the Fontan operation.
Methodsand subjects: We retrospectively reviewed clinical information from medical records of 519 patients at ≥10 years after undergoing the Fontan operation at our institute. The patients were divided into Group A (n = 326; postoperative period, ≥10 to ≤20 years), Group B (n = 166, postoperative period, ≥20 to ≤30 years), and Group C (n=25, postoperative period, ≥30 years).
Results: Overall survival at 30 years was 80%. Patients with NYHA class II or higher accounted for 21% of Group A, 30% of Group B, and 60% of Group C, increasing with longer postoperative period. Employment/school enrollment rates exceeded 80% in all groups. Patients treated for arrhythmias accounted for 25% of Group A, 59% of Group B, and 91% of Group C. All but one patient with a postoperative period exceeding 30 years was treated for arrhythmia, and atrial fibrillation persisted in 33% of these patients. The incidence of protein-losing enteropathy was 2% in Group A, 2.5% in Group B, and 8% in Group C. The incidences of thromboembolism or intra-atrial thrombus were 3%, 10%, and 50%, respectively, being extremely high in Group C. All patients in Group C were on anticoagulant therapy. Hepatic cirrhosis occurred in 44% of Group B and 60% of Group C.
Conclusion: When 30 years or more have elapsed after the Fontan operation, 60% of patients have NYHA class II or higher and almost require arrhythmia treatment. Moreover, thrombus formation is observed in half of patients, and the incidence of hepatic cirrhosis is also high. These data are expected to show worsening outcomes over time.
- © 2013 by American Heart Association, Inc.