title: Outcome after Fontan failure and takedown to an intermediate palliative circulation.
abstract: BACKGROUND
  Fontan takedown to an intermediate palliative circulation is an important treatment option for patients with acute or subacute failure of a Fontan circulation from a variety of causes. Little is known about the subsequent outcome of these patients or their potential candidacy for a second attempt at Fontan completion.
  
  
  METHODS
  Patients followed up at Children's Hospital Boston who underwent takedown of a Fontan circulation to an intermediate palliative circulation within 1 year of Fontan completion were reviewed.
  
  
  RESULTS
  Between 1979 and 2006, 53 patients underwent Fontan takedown at a median age of 2.3 years (range, 0.3 to 36.5 years). Takedown was performed during the Fontan procedure itself in 12 patients (22%), within the first postoperative month in 31(58%), and between 1 month and 1 year in 10 (18%). Overall, 29 patients (55%) survived the early period after takedown, and 19 ultimately underwent successful Fontan completion a median of 4.6 years after takedown; all but one was alive a median of 6.4 years later. Thirteen (68%) of the 19 had treatable abnormalities contributing to Fontan failure.
  
  
  CONCLUSIONS
  Fontan takedown can provide effective stabilization of the acutely or subacutely failing Fontan circulation, although a substantial number of patients die early despite Fontan takedown. Subjects surviving the perioperative period can often undergo uneventful redo Fontan. A thorough evaluation for treatable abnormalities should be performed in all patients with a failing Fontan circulation and in patients who undergo Fontan takedown.
authors.affiliation: Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Christopher S D
authors.initials: CS
authors.lastname: Almond
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003326:Coronary Circulation; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000002:abnormalities; D012189:Retrospective Studies; D017211:Treatment Failure