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20 years of experience with the Fontan procedure: characteristics and clinical outcomes of children in a tertiary referral hospital

Published online by Cambridge University Press:  07 October 2022

Jaiber A. Gutiérrez-Gil ,
Laura A. Torres-Canchala ,
Leidy D. Castro-Viáfara ,
Manuela Uribe-Mora ,
Juan F. Vélez-Moreno ,
Valentina Mejía-Quiñones Open the ORCID record for Valentina Mejía-Quiñones [Opens in a new window]  and
Walter Mosquera-Álvarez
Jaiber A. Gutiérrez-Gil
Affiliation:
Departamento de Cardiología Pediátrica, Fundación Valle del Lili, Cali, Colombia
Laura A. Torres-Canchala
Affiliation:
Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
Leidy D. Castro-Viáfara
Affiliation:
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
Manuela Uribe-Mora
Affiliation:
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
Juan F. Vélez-Moreno
Affiliation:
Departamento de Cardiología Pediátrica, Fundación Valle del Lili, Cali, Colombia
Valentina Mejía-Quiñones*
Affiliation:
Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
Walter Mosquera-Álvarez
Affiliation:
Departamento de Cardiología Pediátrica, Fundación Valle del Lili, Cali, Colombia
*
Author for correspondence: Valentina Mejía-Quiñones, MD, Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18 - 49, Cali 760032, Colombia. Tel: +57 2 3319090; Ext: 4022. E-mail: valentina.mejia@fvl.org.co
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Abstract

Introduction:

Without participating in a contractile chamber, the Fontan procedure seeks to create a separation of oxygenated and deoxygenated blood in patients with univentricular heart, reducing the risks of long-term hypoxemia and improving their survival. This study describes the clinical outcomes of children undergoing the Fontan procedure between 2000 and 2020 in a tertiary referral hospital care centre in southwestern Colombia.

Materials and methods:

A retrospective observational descriptive study. The 81 patients who underwent the Fontan procedure were included. Categorical variables were presented with percentages and continuous variables with measures of central tendency according to the distribution of the data evaluated through the Shapiro–Wilk test. Sociodemographic, clinical, surgical variables, complications, and mortality were described.

Results:

Between 2000 and 2020, 81 patients underwent the Fontan procedure: 43 (53.1%) males and a median age of 5.3 years (interquartile range 4.3–6.6). The most common diagnosis was tricuspid atresia (49.4%). The median mean pulmonary arterial pressure was 12 mmHg (interquartile range 10–15), the Nakata index 272 mm2/m2 (interquartile range 204–327), and the McGoon index (interquartile range 1.86–2.3). Seventy-two (88.9%) patients underwent extracardiac Fontan and 44 (54.3%) patients underwent fenestration. The median hospitalisation days were 19 days. The main complication was coagulopathy (19.8%), mortality in the first month between 2000 and 2010 was 8.6%, and after 2010 was 1.2%.

Conclusion:

The Fontan procedure is a palliative surgery for children with complex heart disease. According to anatomical and physiological variables, the proper choice of patients determines the short- and long-term results.

Keywords

Fontan procedureCHD surgeryfunctionally univentricular circulationoutcomes
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 8 , August 2023 , pp. 1378 - 1382
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Copyright
© Fundación Valle del Lili, 2022. Published by Cambridge University Press

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References

Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240–248.CrossRefGoogle ScholarPubMed
Jones, MB. The Fontan procedure for single-ventricle physiology. Crit Care Nurse 2018; 38: e1–e10.CrossRefGoogle ScholarPubMed
Cazzaniga, M, Pineda, LF, Villagrá, F, et al. Operación modificada de Fontan o variantes efectuadas en un solo tiempo quirúrgico. Determinantes de la mortalidad. Rev Esp Cardiol 2002; 55: 391–412.CrossRefGoogle Scholar
Bridges, ND, Jonas, RA, Mayer, JE, Flanagan, MF, Keane, JF, Castaneda, AR. Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Early results. Circulation 1990; 82 (Suppl 5):IV 170–176.Google ScholarPubMed
Humes, RA, Feldt, RH, Porter, CJ, Julsrud, PR, Puga, FJ, Danielson, GK. The modified Fontan operation for asplenia and polysplenia syndromes. J Thorac Cardiovasc Surg 1988; 96: 212–218.CrossRefGoogle ScholarPubMed
Marcelletti, C, Como, A, Giannico, S, Marino, B. Inferior vena cava-pulmonary artery extracardiac conduit. J Thorac Cardiovasc Surg 1990; 100: 228–232.CrossRefGoogle ScholarPubMed
Bridges, ND, Lock, JE, Castaneda, AR. Baffle fenestration with subsequent transcatheter closure. Modification of the Fontan operation for patients at increased risk. Circulation 1990; 82: 1681–1689.CrossRefGoogle ScholarPubMed
Gargiulo, GD, Bassareo, PP, Careddu, L, Egidy-Assenza, G, Angeli, E, Calcaterra, G. What have we learnt 50 years after the first Fontan procedure? J Cardiovasc Med 2020; 21: 349–358.CrossRefGoogle ScholarPubMed
Nakano, T, Kado, H, Tatewaki, H, et al. Results of extracardiac conduit total cavopulmonary connection in 500 patients. Eur J Cardiothorac Surg 2015; 48: 825–832.CrossRefGoogle ScholarPubMed
Schwartz, I, McCracken, CE, Petit, CJ, Sachdeva, R. Late outcomes after the Fontan procedure in patients with single ventricle: a meta-analysis. Heart 2018; 104: 1508–1514.CrossRefGoogle ScholarPubMed
d’Udekem, Y, Iyengar, AJ, Galati, JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 2014; 130 (11_suppl_1): S32–S38.CrossRefGoogle ScholarPubMed
Kay, WA, Moe, T, Suter, B, et al. Long term consequences of the Fontan procedure and how to manage them. Prog Cardiovasc Dis 2018; 61: 365–376.CrossRefGoogle Scholar
Bolio, A, Ruiz, S, Romero, P, Hernández, G, Villasís, MÁ. Pronóstico de niños cardiópatas sometidos a cirugía de Fontan: experiencia de treinta años en el Hospital Infantil de México Federico Gómez. Bol Med Hosp Infant Mex 2013; 70: 8.Google Scholar
Vargas, N, Vargas, A, Castilla, G, Rodríguez, M, Martínez, L. Cirugía de Fontan: complicaciones posquirúrgicas. Medellín, Colombia. Arch Pediatría Urug 2014; 85: 91–94.Google Scholar
Calderón, J, Ramírez, S, Viesca, R, et al. Cirugía de Fontan. Factores de riesgo a corto y mediano plazo. Arch Cardiol Méx 2005; 75: 425–434.Google Scholar
Gentles, TL, Mayer, JE Jr, Gauvreau, K, et al. Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg 1997; 114: 376–391.CrossRefGoogle ScholarPubMed
Bridges, ND, Mayer, JE, Lock, JE, et al. Effect of baffle fenestration on outcome of the modified Fontan operation. Circulation 1992; 86: 1762–1769.CrossRefGoogle ScholarPubMed
Mendoza, A, Albert, L, Ruiz, E, et al. Fontan operation. Hemodynamic factors associated with postoperative outcomes. Rev Esp Cardiol Engl Ed 2012; 65: 356–362.CrossRefGoogle ScholarPubMed
Kverneland, LS, Kramer, P, Ovroutski, S. Five decades of the Fontan operation: a systematic review of international reports on outcomes after univentricular palliation. Congenit Heart Dis 2018; 13: 181–193.CrossRefGoogle ScholarPubMed
Song, F, Klaus, V, Hakan, A, Dietmar, S. Fontan extracardiac tunnel connection: fenestration or not? Chin Med J (Engl) 2009; 122: 2335–2338.Google Scholar
Bouhout, I, Ben-Ali, W, Khalaf, D, Raboisson, MJ, Poirier, N. Effect of fenestration on fontan procedure outcomes: a meta-analysis and review. Ann Thorac Surg 2020; 109: 1467–1474.CrossRefGoogle ScholarPubMed
Bezuska, L, Lebetkevicius, V, Sudikiene, R, Liekiene, D, Tarutis, V. 30-year experience of Fontan surgery: single-centre’s data. J Cardiothorac Surg 2017; 12: 67.CrossRefGoogle ScholarPubMed