Details

Autor(en) / Beteiligte

• Pundi, Kavitha N
• Johnson, Jonathan N
• Dearani, Joseph A
• Pundi, Krishna N
• Li, Zhuo
• Hinck, Cynthia A
• Dahl, Sonja H
• Cannon, Bryan C
• O'Leary, Patrick W
• Driscoll, David J
• Cetta, Frank

Titel

40-Year Follow-Up After the Fontan Operation: Long-Term Outcomes of 1,052 Patients

Ist Teil von

• Journal of the American College of Cardiology, 2015-10, Vol.66 (15), p.1700-1710

Ort / Verlag

United States

Erscheinungsjahr

2015

Link zum Volltext

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation. This study sought to determine the long-term outcome of all patients who had a Fontan operation at the Mayo Clinic. Records of all patients who had a modified Fontan operation between 1973 and 2012 were reviewed. A follow-up questionnaire was mailed to all patients alive at the time of the study. Overall, 10-, 20-, and 30-year survival for 1,052 patients was 74%, 61%, and 43%, respectively. Factors associated with decreased overall or late survival in multivariate analysis included pre-operative diuretic use, longer cardiopulmonary bypass time, operation prior to 1991, atrioventricular valve (AVV) replacement at the time of Fontan operation, elevated post-bypass Fontan (>20 mm Hg) or left atrial (>13 mm Hg) pressures, prolonged chest tube drainage (>21 days), post-operative ventricular arrhythmias, renal insufficiency, and development of protein-losing enteropathy (PLE). Pre-operative and intraoperative sinus rhythm were associated with improved survival. Long-term survival was similar for patients regardless of ventricular morphology. The most common reoperations were pacemaker insertion/revision in 212 patients (20%), Fontan revision/conversion in 117 patients (11%), and AVV repair/replacement in 66 patients (5%). Clinically significant late atrial or ventricular arrhythmias occurred in 468 patients (44%). Ninety-five patients (9%) developed PLE, and 5-, 10-, and 20-year survival after diagnosis of PLE was 50%, 35%, and 19%, respectively. As the surgical techniques for the Fontan operation have changed over the last 40 years, survival has improved. However, development of PLE and arrhythmias and the need for reoperation during long-term follow-up pose significant management challenges.