Outcome after Fontan failure and takedown to an intermediate palliative circulation.
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.
Almond
Christopher S D
CS
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
Mayer
John E
JE
Thiagarajan
Ravi R
RR
Blume
Elizabeth D
ED
del Nido
Pedro J
PJ
McElhinney
Doff B
DB
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