High-risk Fontan completion patients achieve low perioperative risk and benefit from cavopulmonary connection 7 years out

• Published in: European journal of cardio-thoracic surgery 2019-10, Vol.56 (4), p.664-670
• Main Authors: Vigano, Gaia, McMahon, Colin J, Walsh, Kevin, Oslizlok, Paul, Franklin, Orla, Nolke, Lars, Redmond, John M, Byrne, John, McGuinness, Jonathan G
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Fontan Procedure - methods; Humans; Male; Postoperative Complications - epidemiology; Pulmonary Artery - surgery; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome; Vena Cava, Superior - surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezz069

Abstract OBJECTIVES: Our unit has pursued Fontan completion in all patients except those with immobility or combined poor ventricular function and high pulmonary artery pressures. We assessed retrospectively whether conventional high-risk criteria would predict patients with a poorer outcome. METHODS: One hundred and thirty-three consecutive children who underwent extracardiac Fontan completion (2004–2012) had their outcomes recorded (mean follow-up of 7 years). Three groups were analysed: those with 1 of 6 historical risk factors (outside 6 commandments), those with 1 of reduced systemic ventricular function or pulmonary artery pressure >15 mmHg (outside 2 commandments) versus those with no contraindications. The Fischer’s exact test examined frequency differences, with the χ2 test to look for outcome associations. RESULTS: There were no differences in postoperative complication rates between the outside 6 commandments (n = 105) or outside 2 commandments (n = 49) versus the low-risk no-contraindication group (n = 28): arrhythmias [18% (P = 0.3) or 18% (P = 0.3) vs 25%], infection [22% (P = 0.6) or 33% (P = 0.2) vs 21%], cerebrovascular accident [6% (P = 0.5) or 10% (P = 0.3) vs 4%], length of stay [20 days (P = 0.4) or 23 days (P = 0.2) vs 21 days] and duration of chest drainage (P = 0.5). There was 1 predischarge mortality in each group. Long term, the majority of patients in each group had suitable haemodynamics for fenestration closure [95% (P = 0.7) or 95% (P = 0.7) vs 92%]. Long term, there was no difference in the rate of arrhythmias [11% (P = 0.5) or 12.5% (P = 0.3) vs 7%], protein-losing enteropathy [1% (P = 0.1) or 2% (P = 0.3) vs 7%] or moderate or more ventricular dysfunction on echocardiography [2% (P = 0.7) or 4% (P = 0.7) vs 4%]. Notably, there was a higher rate of catheter reinterventions in the high-risk groups [22% (P