title: The Fontan operation: the pursuit of associated lesions and cumulative trauma.
abstract: Our programmatic approach to the Fontan operation has evolved to include using an extracardiac conduit with aggressive presumptive treatment of associated lesions either in the catheterization laboratory or the operating room. Fenestration is used selectively based on hemodynamics, anatomy, and presence of associated lesions. We reviewed our experience to determine the effectiveness and outcome of this strategy and to assess the cumulative trauma to the patients. The records of 137 consecutive patients who underwent Fontan at Miami Children's Hospital from 1995 to 2008 were reviewed. At mean follow up of 5.76 years, freedom from death or transplantation is 94.2% (129/137). Median age at operation was 4.6 years. Longer length of stay correlated with older operative age (P = 0.0056). Pacemakers were implanted in 11.7% (16/137). Additional (not pre-Glenn or pre-Fontan) interventional catheterizations were performed in 51.8% (71/137). Additional operations were done in 10.2% (14/137). No patient has required replacement or revision of the extracardiac conduit. Our current approach to the Fontan operation provides acceptable midterm results. The pursuit of residual lesions results in a significant number of additional interventional catheterizations and operative procedures but might have an important influence on long-term survival after the Fontan procedure.
authors.affiliation: Department of Cardiovascular Surgery, Congenital Heart Institute at Miami Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA. rhannan001@aol.com
authors.forename: Robert L
authors.initials: RL
authors.lastname: Hannan
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Zabinsky
authors.forename: Jane L
authors.initials: JL
authors.lastname: Salvaggio
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Rossi
authors.forename: Danyal M
authors.initials: DM
authors.lastname: Khan
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Alonso
authors.forename: Jorge W
authors.initials: JW
authors.lastname: Ojito
authors.forename: David G
authors.initials: DG
authors.lastname: Nykanen
authors.forename: Evan M
authors.initials: EM
authors.lastname: Zahn
authors.forename: Redmond P
authors.initials: RP
authors.lastname: Burke
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome