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DOI: 10.1055/s-0039-1678786
Extracardiac Conduit versus Lateral Atrial Tunnel Fontan Operation—Analysis of the Mid-term Complications
Publication History
Publication Date:
28 January 2019 (online)
Objectives: During almost five decades, the technique of Fontan operation (FO) underwent many modifications, and nowadays, there are generally two operative methods which are used as a total cavopulmonary anastomosis: lateral tunnel (LT) and extracardiac conduit (EC). The aim of the study was to compare the mid-term outcomes after LT and EC FO.
Methods: Between May 2007 and December 2017, 317 patients underwent FO performed by the same surgical team. The cross-sectional study included 270 children (LT = 40 and EC = 230) from whom sufficient follow-up data were obtained. Parents, patients, or their curators were asked for all medical data they possess and follow-up surveys were conducted. The data were retrospectively reviewed focusing on the following complications: arrhythmia, protein-losing enteropathy, plastic bronchitis, liver failure, and thromboembolic events.
Results: The mean age at FO was 3.6 ± 2.6 years (range, 1.35–22.1 years) and mean follow-up was 4.39 ± 2.73 years (range, 0.12–10.44 years) with the hospital mortality of 0.4% (N = 1) and follow-up mortality of 1.85% (N = 5). The 1- and 5-year freedom from complications was 94 and 85% for EC, and 92.5 and 60% for LT patients (p = 0.303). Less children from EC group than from LT group suffered from arrhythmic events and/or complications (5 vs. 32.5%; p ˂ 0.001), as well less patients required a permanent pacemaker implantation due to the bradyarrhythmia (1 vs. 12.5%; p = 0.008). There were no differences between the groups regarding the incidence of other analyzed complications (as shown in table).
Conclusion: The early- to mid-term outcomes of FO show low rate of complications. Children after extracardiac conduit FO present excellent results with low morbidity rates. Patients after lateral atrial tunnel suffer primarily from rhythm-related complications.
Morbidity after Fontan operation |
Lateral tunnel (N = 40) |
Extracardiac conduit (N = 230) |
Total (N = 270) |
p-Value |
---|---|---|---|---|
Overall complication occurrence |
16 (40.0%) |
35 (15.0%) |
51 (19.0%) |
0.303 |
Arrhythmic event/complication |
13 (32.5%) |
12 (5.0%) |
25 (9.3%) |
˂0.001 |
Pacemaker implantation |
5 (12.5%) |
2 (1.0%) |
7 (2.6%) |
0.008 |
Plastic bronchitis |
1 (3.0%) |
5 (2.0%) |
6 (2.2%) |
0.619 |
Protein-losing enteropathy |
3 (8.0%) |
11 (5.0%) |
14 (5.2%) |
0.868 |
Thromboembolic event |
2 (5.0%) |
6 (3.0%) |
8 (3.0%) |
0.721 |
Required catheterization |
15 (38.0%) |
49 (21.0%) |
64 (23.7%) |
0.676 |
Required reoperation |
3 (8.0%) |
6 (3.0%) |
9 (3.3%) |
0.252 |
Required hospital admission |
24 (60.0%) |
82 (36.0%) |
106 (39.3%) |
0.663 |