Surgical options after Fontan failure.
- van Melle JP Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Wolff D Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Hörer J Technical University, German Heart Center Munich, Munich, Germany.
- Belli E Department of Congenital Heart Disease, Centre Chirurgical Marie Lannelongue, Paris, France.
- Meyns B Department of Cardiac Surgery, Catholic University Leuven, Leuven, Belgium.
- Padalino M Pediatric and Congenital Cardiovascular Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padua, Italy.
- Lindberg H Department of Thoracic and Cardiovascular Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
- Jacobs JP Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, USA Johns Hopkins University, Baltimore, Maryland, USA.
- Mattila IP Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
- Berggren H Children's Heart Centre, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
- Berger RM Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Prêtre R Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.
- Hazekamp MG Leiden University Medical Center, Leiden, The Netherlands Academic Medical Center, Amsterdam, The Netherlands.
- Helvind M Department of Cardio-Thoracic Surgery, University Hospital of Copenhagen, Copenhagen, Denmark.
- Nosál M National Institute of Cardiovascular Disease, Children's Heart Centre Slovak Republic, Bratislava, Slovakia.
- Tlaskal T Department of Pediatric Cardiac Surgery, Children's Heart Center, Motol University Hospital, Prague, Czech Republic.
- Rubay J Division of Cardiac Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
- Lazarov S National Heart Hospital Sofia, Sofia, Bulgaria.
- Kadner A Department of Cardiovascular Surgery, Center for Congenital Heart Surgery, University Hospital Bern, Bern, Switzerland.
- Hraska V German Pediatric Heart Centre, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.
- Fragata J Department of Cardiothoracic Surgery, Hospital de Santa Marta, Lisbon, Portugal.
- Pozzi M Department of Congenital and Paediatric Cardiac Surgery and Cardiology, Riuniti Hospital, Ancona, Italy.
- Sarris G Athens Heart Surgery Institute, Athens, Greece Department of Pediatric, Congenital Heart Surgery at IASO Children's Hospital, Athens, Greece.
- Michielon G Department of cardiothoracic surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- di Carlo D Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Roma, Italia.
- Ebels T Department of cardiothoracic surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- 2016-04-15
Published in:
- Heart (British Cardiac Society). - 2016
Adolescent
Adult
Child
Child, Preschool
Europe
Female
Fontan Procedure
Heart Defects, Congenital
Heart Transplantation
Humans
Infant
Kaplan-Meier Estimate
Male
Postoperative Complications
Proportional Hazards Models
Retrospective Studies
Risk Factors
Time Factors
Treatment Failure
Young Adult
English
OBJECTIVE
The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX.
METHODS
A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%).
RESULTS
The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04).
CONCLUSIONS
Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.
The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX.
METHODS
A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%).
RESULTS
The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04).
CONCLUSIONS
Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1136/heartjnl-2015-309235
- PMID 27076374
- Persistent URL
- https://sonar.ch/global/documents/233031
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