title: Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection.
abstract: BACKGROUND
  Extracardiac conduit and lateral atrial tunnel total cavopulmonary connection are both widely used in the management of functionally univentricular hearts. The effect of the type of connection on early outcomes after Fontan operation remains unclear. We evaluated the effect of Fontan type on early outcome in a large clinical database.
  
  
  METHODS
  Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000 to 2009) were included. We used multivariable analysis to evaluate the effect of Fontan type (extracardiac conduit vs lateral tunnel) on in-hospital death, Fontan takedown/revision, Fontan failure (in-hospital death or Fontan takedown/revision), postoperative length of stay, and complications, adjusting for patient, procedural, and center factors.
  
  
  RESULTS
  The study included 2,747 patients (61% male) from 68 centers. A right-dominant ventricle was present in 45%. Extracardiac conduit Fontan (vs lateral atrial tunnel) was performed in 63%; in all, 65% were fenestrated. In multivariable analysis with adjustment for patient, procedural (including fenestration), and center factors (including Fontan volume), the extracardiac conduit Fontan was associated with significantly higher Fontan takedown/revision (odds ratio, 2.73; 95% confidence interval, 1.09 to 6.87) and Fontan failure (odds ratio, 2.28; 95% confidence interval, 1.13 to 4.59), and longer postoperative hospital stay (adjusted estimated difference in postoperative hospital stay: +1.4 days).
  
  
  CONCLUSIONS
  These multicenter data suggest that of the two prevalent forms of Fontan connection in current use, the lateral atrial tunnel Fontan may be associated with superior early outcomes.
authors.affiliation: Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stewart
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Julie
authors.initials: J
authors.lastname: Cheng
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality*; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome