Clinical outcome of the Fontan operation in patients with impaired ventricular function.
OBJECTIVE
Although a staged Fontan strategy allows for an excellent outcome in high-risk patients, an impaired ventricular function remains a significant factor of early/late mortality and morbidity. This study evaluated the clinical outcome of the Fontan operation in patients with impaired ventricular function.


METHODS
A retrospective review was performed on 217 patients who had undergone the Fontan operation between 1991 and 2007.


RESULTS
Twenty-nine (13%) of the 217 patients had an impaired ventricular function (ejection fraction (EF) <50%). The median age at the time of the operation was 3 (range: 1-31 years) years. There were five adult patients. The ventricular morphology was right in 20 patients (including five hypoplastic left heart syndrome (HLHS)) and others (left and two-ventricle) in nine patients. Heterotaxy syndrome was present in eight patients. Previous surgical interventions included bidirectional Glenn anastomoses in 24, modified Blalock-Taussig shunts in two and pulmonary artery banding in two. The preoperative EF was 43+/-6%. Significant (moderate or severe) atrioventricular valve regurgitation was noted in four patients. The percutaneous oxygen saturation (SpO(2)) was 82+/-5%. The pulmonary artery pressure and pulmonary artery index were 11+/-3 mmHg and 296+/-102 mm(2)m(-2), respectively. All 29 patients underwent the Fontan operation without any early mortality. There were two late mortalities and two re-operations. EF was maintained at 59+/-15% at a median follow-up of 7.5 (range: 1-19) years. The percent normal systemic ventricular end-diastolic volume decreased from 174+/-95% to 124+/-39% (p<0.05). The SpO(2) increased to 92+/-2%. The mean cardiothoracic ratio in chest X-ray and B-type natriuretic peptide were 51% (range: 35-68%) and 22 pgml(-1) (range: 9-382 pgml(-1)), respectively. Three patients developed congestive heart failure, seven had arrhythmia and two developed protein-losing enteropathy. The New York Heart Association (NYHA) class functional class is I in 21 patients, II in five and III in one.


CONCLUSIONS
Acceptable clinical outcomes were observed at an intermediate follow-up of the Fontan operation in patients with an impaired ventricular function.
Kotani
Yasuhiro
Y
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama City, Okayama 700-8558, Japan.
Kasahara
Shingo
S
Fujii
Yasuhiro
Y
Yoshizumi
Ko
K
Oshima
Yu
Y
Otsuki
Shin-Ichi
S
Akagi
Teiji
T
Sano
Shunji
S
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007223:Infant; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D013318:Stroke Volume; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000150:complications / Q000601:surgery*; D055815:Young Adult
D010100:Oxygen