1. Risk Factors for Failed Fontan Procedure After Stage 2 Palliation
- Author
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Alfred Hager, Benedikt Mayr, Jürgen Hörer, Masamichi Ono, Melchior Burri, Martina Strbad, Rüdiger Lange, Lisa Anderl, and Julie Cleuziou
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Fontan Procedure ,Hypoplastic left heart syndrome ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,medicine.artery ,Hypoplastic Left Heart Syndrome ,medicine ,Humans ,cardiovascular diseases ,Risk factor ,Child ,Retrospective Studies ,Cardiac catheterization ,business.industry ,Heart Septal Defects ,Palliative Care ,Hazard ratio ,Retrospective cohort study ,medicine.disease ,Surgery ,Treatment Outcome ,030228 respiratory system ,Echocardiography ,Child, Preschool ,Pulmonary artery ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Our aim was to evaluate the results of stage 2 palliation by means of bidirectional cavopulmonary shunt (BCPS) and to identify risk factors for failed Fontan completion.Between 1998 and 2018, BCPS was performed on 525 patients with functional single ventricle. Patient demographics, surgical data, and echocardiographic and cardiac catheterization measurements were analyzed, and outcomes after BCPS were evaluated.The median age at BCPS was 4.7 months (interquartile range, 3 to 7.4). Hypoplastic left heart syndrome was the most frequent diagnosis. The median follow-up after BCPS was 3.4 years (interquartile range, 1.5 to 8.7); 407 patients underwent the Fontan procedure, 50 were waiting for Fontan completion, 47 died, 6 were considered not suitable for Fontan completion, and 15 were lost to follow-up. Of the 407 patients who underwent Fontan completion, there were 5 early deaths. Freedom from failed Fontan completion (mortality before, unsuitability for, and early mortality after the Fontan procedure) at 1, 2, and 3 years was 91.9%, 87.3%, and 86.1%, respectively. Risk factor analysis for failed Fontan completion revealed hypoplastic left heart syndrome (hazard ratio [HR] 4.1, P = .001), unbalanced atrioventricular septal defect (HR 10.1, P.001), higher pulmonary artery pressure (HR 1.1, P = .040), and reduced ventricular function (HR 4.2, P = .001) as risks.Stage 2 palliation can be performed with minimal risk and provides excellent subsequent Fontan completion. Hypoplastic left heart syndrome, unbalanced atrioventricular septal defect, high pulmonary artery pressure, and reduced ventricular function at the time of BCPS were identified as risk factors for failure to successfully complete the Fontan procedure.
- Published
- 2021
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