Clinical outcomes of Fontan conversion surgery with and without associated arrhythmia intervention.
OBJECTIVE
To characterize mortality and morbidity outcomes in patients undergoing surgical Fontan conversion.


BACKGROUND
Indications for and anticipated clinical outcomes associated with Fontan conversion are controversial.


METHODS
A retrospective single-center cohort study of consecutive patients undergoing Fontan conversion between 1990 and 2006 stratified according to concomitant arrhythmia surgery.


RESULTS
Forty patients underwent Fontan conversion at a median age of 19.0 years and were followed for 4.2 years. Six (15%) died, two perioperatively, three early postoperatively, and one following heart transplant. Older age was a univariate risk factor. Major perioperative complications occurred in 9 of 35 (26%) early survivors. Patients with concomitant arrhythmia surgery (N=21) were older at conversion and had longer interoperative intervals. They experienced a reduction in prevalence (95% vs. 28%, P<0.0001) and severity (severity score 7.3 vs. 3.3, P=0.001) of atrial tachyarrhythmias, in contrast to patients without arrhythmia surgery (47% vs. 53%; 3.3 vs. 3.9, P=NS). NYHA functional class improved in both groups. In a subgroup (N=14) with non-urgent late postoperative catheterization, filling pressures were unchanged from preoperative values.


CONCLUSIONS
Mortality and morbidity after Fontan conversion are substantial, but survivors experience a subjective improvement in functional status. Concomitant arrhythmia surgery reduces the arrhythmia burden without a detectable increase in complication rates.
Takahashi
Kazuhiro
K
Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
Fynn-Thompson
Francis
F
Cecchin
Frank
F
Khairy
Paul
P
del Nido
Pedro
P
Triedman
John K
JK
D000293:Adolescent; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult