Fontan operation. Hemodynamic factors associated with postoperative outcomes.
OBJECTIVE
The Fontan operation is usually the final palliative procedure in patients with univentricular heart. The objectives of this study were, firstly, to describe the clinical and haemodynamic characteristics of a group of patients with univentricular physiology who had previously been palliated with a bidirectional Glenn procedure and, secondly, to identify risk factors that can influence postoperative outcomes after the Fontan operation.


METHODS
Retrospective study with 32 patients who underwent a Fontan operation between March 2000 and December 2009. Clinical characteristics, catheterization data, type and duration of surgery were revised and analyzed as predictors of postoperative outcome.


RESULTS
Hospital mortality was 3%. After a median follow-up of 44 months (interquartile range, 32-79), survival was 90%. Preoperative mean pulmonary artery pressure (measured during catheterization) was correlated with late mortality. Of the remaining variables analyzed, the Nakata and McGoon indices, and duration of cardiopulmonary bypass showed the highest correlations with postoperative outcomes. Interventional catheterization before the Fontan operation was performed in 42% of patients.


CONCLUSIONS
Hospital mortality after the Fontan operation was very low. The performance of a haemodynamic study before the Fontan operation made it possible to select high-risk patients for surgery as well as permitting the performance of interventional procedures that could improve postoperative outcome in these patients.
Instituto Pediátrico del Corazón, Hospital 12 de Octubre, Madrid, Spain. amendozas.hdoc@salud.madrid.org
Alberto
A
Mendoza
Leticia
L
Albert
Enrique
E
Ruiz
Lorenzo
L
Boni
Victoria
V
Ramos
Jose M
JM
Velasco
Dolores
D
Herrera
Miguel A
MA
Granados
Juan V
JV
Comas
Ana
A
Perez
D006328:Cardiac Catheterization; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome