High frequency of arrhythmias after Fontan operation indicates earlier anticoagulant therapy.
BACKGROUND
As patients began to survive for longer periods following modified Fontan operations (conventional atrio-pulmonary connection), the late morbidity after this procedure became increasingly apparent. The purpose of the present study was to evaluate late sequelae of modified Fontan operations in long-term survivors (n=14) at our institute.


RESULTS
The cohort consisted of patients who underwent a modified Fontan operation between 1981 and 1990. Thus, all patients were examined at least 10 years postoperatively in this study. Early mortality, within 30 days of the operation, was 17.6% (three of 17 patients died from low output syndrome). Excluding these early deaths, the cumulative survival rate at 5 and 10 years was 100 and 79%, respectively. Arrhythmias including atrial fibrillation or flutter were the main late causes of morbidity. The arrhythmia-free rate at 5 and 10 years was 77 and 50%, respectively. Although the quality of life was considered good because all patients (n=11) who survived for 10 years or more were in class I or II according to the New York Heart Association classification, most of them in fact suffered from potentially life-threatening arrhythmias.


CONCLUSIONS
Meticulous attention to and utilization of established treatment strategies for arrhythmias including anti-arrhythmics, anticoagulants, catheter ablation or re-operation converting the circulation to the total cavopulmonary connection must be considered in long-term survivors following the modified Fontan operation. The fact that no one knows when the thrombogenic arrhythmias occur suggests anticoagulants should be initiated in the early postoperative period.
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Cho-ku, Sapporo 060-8556, Japan. satoru-sugimoto@hokkaido.med.or.jp
S
S
Sugimoto
N
N
Takagi
Y
Y
Hachiro
T
T
Abe
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D011788:Quality of Life; D013997:Time Factors
D000925:Anticoagulants