J. Maxwell Chamberlain Memorial Paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery: surgical lessons and outcomes.
BACKGROUND
The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome.


METHODS
Since 1994, 111 patients (mean age 22.5 +/- 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III).


RESULTS
There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 +/- 12.1 days. Mean cross-clamp time was 70.8 +/- 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3).


CONCLUSIONS
Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.
Mavroudis
Constantine
C
Division of Cardiovascular Thoracic Surgery, Children's Memorial Hospital, Northwestern University, Chicago Illinois 60614, USA. cmavroudis@childrensmemorial.org
Deal
Barbara J
BJ
Backer
Carl L
CL
Stewart
Robert D
RD
Franklin
Wayne H
WH
Tsao
Sabrina
S
Ward
Kendra M
KM
DeFreitas
R Andrew
RA
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D007223:Infant; D012008:Recurrence; D012189:Retrospective Studies