title: Surgical evaluation of the modified Fontan procedure.
abstract: From 1980 to 1990 152 patients underwent Fontan operation at our institution. The following patient groups were identified: 1. patients with tricuspid atresia (n = 82, 54.0%); 2. patients with single ventricle (n = 31, 20.3%); 3. patients with a wide variety of non correctable, complex cardiac malformations (n = 39, 25.7%). In 27.0% of the patients a primary Fontan operation was performed. 45.0% of the patients received a previous shunt to increase pulmonary blood flow and in 29.4% of the patients a pulmonary artery band was placed to reduce pulmonary flow. Overall mortality was not significantly different in patients with previous palliative procedures (19.4%, n = 18) as compared to 17.4% (n = 6) in patients with primary Fontan operation. Risk of death was high in the group with complex cardiac malformations (28.2%, n = 11) and in patients with single ventricle (19.4%, n = 6). Early mortality was considerably less in patients tricuspid atresia (8.5%, n = 7). Postoperatively patients with incorporation of the residual right ventricular chamber and pulmonary valve (Fontan-Bjoerk) showed a significant (p less than 0.05) lower incidence of pleural effusion as compared to patients with other modifications of the Fontan procedure. Actuarial survival rate of all patients is 83.8 +/- 3.1% (mean +/- SEM) at ten years. The modified Fontan procedures are providing an accepted surgical method for patients with otherwise non correctable cardiac malformations.
authors.affiliation: Klinik für Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum München.
authors.forename: J
authors.initials: J
authors.lastname: Weipert
authors.forename: H
authors.initials: H
authors.lastname: Meisner
authors.forename: C
authors.initials: C
authors.lastname: Haehnel
authors.forename: S U
authors.initials: SU
authors.lastname: Paek
authors.forename: F
authors.initials: F
authors.lastname: Sebening
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D012086:Reoperation; D016019:Survival Analysis