title: Clinical outcomes of Fontan conversion surgery with and without associated arrhythmia intervention.
abstract: 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.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takahashi
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Frank
authors.initials: F
authors.lastname: Cecchin
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Pedro
authors.initials: P
authors.lastname: del Nido
authors.forename: John K
authors.initials: JK
authors.lastname: Triedman
mesh_terms: 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