Details

Autor(en) / Beteiligte

• Wilson, Thomas G, BSc, MD
• Shi, William Y, MBBS
• Iyengar, Ajay J, MBBS(Hons), BMedSci, PhD
• Winlaw, David S, MBBS(Hons), MD, FRACS
• Cordina, Rachael L, MBBS, FRACP
• Wheaton, Gavin R, MBBS, FRACP
• Bullock, Andrew, MBBS, FRACP
• Gentles, Thomas L, MBChB, FRACP
• Weintraub, Robert G, MBBS, FRACP
• Justo, Robert N, MBBS, FRACP
• Grigg, Leeanne E, MBBS, FRACP
• Radford, Dorothy J, MBBS, MD, FRACP
• d'Udekem, Yves, MD, PhD

Titel

Twenty-Five Year Outcomes of the Lateral Tunnel Fontan Procedure

Ist Teil von

• Seminars in thoracic and cardiovascular surgery, 2017, Vol.29 (3), p.347-353

Ort / Verlag

United States

Erscheinungsjahr

2017

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Abstract Objective(s) To characterize late outcomes of the lateral tunnel (LT) Fontan procedure. Methods The outcomes of all patients who underwent a LT Fontan procedure in Australia and New Zealand were analysed. Original files were reviewed and outcomes data were obtained through a binational Registry. Results Between 1980 and 2014, a total of 301 patients underwent a LT Fontan procedure across 6 major centers. There were 13 hospital mortalities, 21 late deaths, 8 Fontan conversions/revisions, 8 Fontan takedowns and 4 heart transplantations. Overall survival at 15 and 25 years was 90% (95% confidence interval [CI]:86-93%) and 80% (95% CI:69-91%), respectively. Protein-losing enteropathy/plastic bronchitis was observed in 14 patients (5%). Freedom from late failure at 15 and 25 years was 88% (95% CI:84-92%) and 82% (95% CI:76-87%), respectively. Independent predictors of late Fontan failure were prolonged pleural effusions post-Fontan operation (HR 3.06,1.05-8.95, p=0.041), age >7 years at Fontan (vs. 3-5 years, HR 9.7, 2.46-38.21, p=0.001) and development of supraventricular tachycardia (4.67, 2.07-10.58, p<0.001). Freedom from tachy- or bradyarrhythmias at 10 and 20 years was 87% (95% CI:83-91%) and 72% (95% CI:66-79%), respectively. Thromboembolic events occurred in 45 patients (16%; 26 strokes), and freedom from symptomatic thromboembolism at 10 and 20 years was 93% (95% CI:89-96%) and 80% (95% CI:74-86%), respectively. Conclusions Over a twenty-five-year period, the LT technique has achieved excellent late survival. As this population ages, they are at increasing risk of failure and adverse events. We are likely to see an increasing proportion requiring heart transplantation and late reintervention.