Abstract 20112: Lateral Tunnel and Extra-Cardiac Fontan Operations Have Equivalent Early and Late Outcomes in the Modern Era
Introduction: Controversy continues regarding lateral tunnel (LT) versus extra-cardiac (EC) Fontan’s. Although we currently perform EC, there was a broad transition period. We aimed to compare long-term outcomes after LT or EC.
A. Total surgical experience: Of 906 Fontan operations (1976-2014), 223 were LT (1987-2005) and 412 EC (1995-2014) (median f/u 8.3 years; range 0-29). Survival and re-operations (including revisions, transplants and pacemakers) were compared.
B. Adults: Our ACHD program follows 102 LT and 78 EC (median 23 years post-Fontan; range 18-40). All were reviewed and risk-adjusted comparisons were made. Additional comparisons used propensity-matched pairs near-identical by diagnosis, morphology, age and era (LT=36, EC=36, parametric greedy matching, c-statistic .885).
Risk-adjustment was via parametric multivariable models and competing risks techniques, with bootstrapping.
A. Early peri-operative mortality after Fontan was strongly era-dependent (P<.0001). Early mortality after LT was significantly higher (13% versus 3% within 1 year, P<.0001). One year after Fontan, long-term attrition was no different between LT and EC. Once adjusted for era, long-term survival, freedom from re-operations, pacemaker or transplant was not different between LT and EC.
B. Adults with LT and EC exhibit comparable risk-adjusted late outcomes (table, figure) by i) unadjusted comparisons, ii) risk-adjusted comparisons and iii) propensity-matched comparisons.
Conclusions: LT and EC in the modern era have equivalent early and late outcomes to 30 years including survival, re-operation, cardiopulmonary function, arrhythmia and Fontan failure.
- Fontan physiology
- Heart failure
- Heart failure, pediatric
- Adult congenital heart disease
- Atrial arrhythmias
Author Disclosures: S. Bartelse: None. S.L. Roche: None. W.G. Williams: None. C. Silversides: None. R. Wald: None. E. Oechslin: None. J. Colman: None. M. Gritti: None. E. Pham-Hung: None. G.S. Van Arsdell: Ownership Interest; Modest; Director, CellAegis Inc. C.A. Caldarone: Ownership Interest; Modest; Director, CellAegis Inc. J. Coles: None. O. Honjo: None. E.J. Hickey: None.
- © 2016 by American Heart Association, Inc.