Fontan completion rate and outcomes after bidirectional cavo-pulmonary shunt

Ann-Marie Tan, Ajay Iyengar, Susan Donath, Andrew Bullock, Gavin Wheaton, Leeanne Grigg, Christian Brizard, Yves d'Udekem

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    Abstract

    Objective: To determine outcomes of patients undergoing a bidirectional cavo-pulmonary shunt (BCPS) in the Fontan era. Methods: From 1990 to 2000, 212 patients underwent a BCPS in a single institution at a mean age of 2.6 ± 5 years. Results: Hospital mortality was 6% (13 patients). Five patients were lost to follow-up (3%). After a mean of 9 ± 4 years, 15 patients had not yet been referred for Fontan surgery and their status was deemed satisfactory (11 11/2 ventricle repair, three BCPS and one patient converted to a bi-ventricular repair). Out of the remaining 179 patients who could potentially have reached a Fontan status, 141 had undergone the procedure and seven were awaiting Fontan completion. The expected completion rate of Fontan surgery after BCPS was 83% (148/179). Thirteen patients died and heart transplantation was necessitated in nine patients. Nine were deemed unsuitable for Fontan surgery for cardiac (seven), respiratory (one) or neurologic (one) reasons. After BCPS, the only predictors of late failure (death, heart transplantation or NYHA class III-IV) were not reaching Fontan status and the presence of bilateral superior vena cava (SVC). Ten-year survival was 99% (95% confidence interval (CI): 95-99%) for Fontan patients and 67% (95%CI: 50-80%) for those left with a BCPS. Conclusion: In the present era, staging with BCPS represents a selection process in the Fontan pathway. Almost a fifth of the patients will not reach Fontan status. Outstanding results after Fontan surgery may hide a high attrition rate between BCPS and Fontan. Crown

    Original languageEnglish
    Pages (from-to)59-65
    Number of pages7
    JournalEuropean Journal of Cardio-Thoracic Surgery
    Volume38
    Issue number1
    DOIs
    Publication statusPublished - Jul 2010

    Keywords

    • Cavo-pulmonary anastomosis
    • Congenital heart surgery
    • Follow-up studies
    • Fontan procedure

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    Tan, A-M., Iyengar, A., Donath, S., Bullock, A., Wheaton, G., Grigg, L., Brizard, C., & d'Udekem, Y. (2010). Fontan completion rate and outcomes after bidirectional cavo-pulmonary shunt. European Journal of Cardio-Thoracic Surgery, 38(1), 59-65. https://doi.org/10.1016/j.ejcts.2010.01.031