Extracardiac Conduit versus Lateral Atrial Tunnel Fontan Operation—Analysis of the Mid-term Complications

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.

Table 1

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