The complication of Fontan procedure using extracardiac conduit

Abstract

Background: Recently, Fontan operation using extracardiac conduit (EC) has grown to be the most common procedure. However, as the existing history is relatively short, prevalence rates of complications have not been clarified. Methods: A retrospective chart review of 644 consecutive patients undergoing Fontan operation with EC was performed in Fukuoka Children's Hospital and Kyushu University Hospital. Results: ” The 10-year and 20-year survival rates were 96.8% and 91.9%, while the 10-year and 20-year freedom rates from Fontan failure were 92.3% and 90.5%. The 20-year cumulative incidence of tachyarrhythmia, bradyarrhythmia, stroke, hemoptysis, acute decompensated heart failure (ADHF), and protein-losing enteropathy (PLE) were 6.6%, 4.0%, 4.9%, 3.1%, 15.0% and 3.9%, respectively. Those with bradyarrhythmia, ADHF, and hemoptysis had a significantly worse outcome in developing Fontan failure. Risk factors for these complications included hypoplastic left heart syndrome, heterotaxy syndrome, previous surgical pulmonary arterial plasty, pacemaker implantation, atrioventricular valvular replacement, higher age at the Fontan procedure, fenestration of the conduit, lower oxygen saturation, higher Fontan pressure, smaller pulmonary arterial size, and moderate to severe atrioventricular valvular regurgitation after the Fontan procedure. Conclusions: Though the long-term survival is acceptable, substantial prevalence of complications was shown among patients receiving Fontan operation with EC. Since some of the complications were associated with developing Fontan failure, they should be monitored carefully.

Keywords

• Fontan procedure
• Extracardiac conduit
• Fontan failure
• Complications