title: Long-term outcome and anaesthetic management for non-cardiac surgery after Fontan palliation: a single-centre retrospective analysis.
abstract: OBJECTIVE
  The improved management of Fontan patients has resulted in good outcome. As such, these patients may necessitate care for non-cardiac surgery. We sought to determine the long-term outcome of our Fontan series palliated with the most recent surgical techniques. Our second objective was to report the incidence and the perioperative course after non-cardiac procedures. We reviewed the records of all patients with either a lateral tunnel or an extracardiac conduit Fontan between 1996 and 2008. Follow-up was recorded until June, 2013, including records regarding non-cardiac interventions.
  
  
  RESULTS
  Overall, 58 patients were included. Of them, one patient underwent a takedown of his Fontan, and five patients died in the immediate postoperative course. The cumulative survival of the remaining 52 patients was 81%. There was no significant difference in survival between right and left ventricle morphologies (p=0.56), nor between both types of Fontan (p=0.9). Chronic arrhythmias (25%), fatigue/dyspnoea (40%), thrombotic complications (19%), and embolic events (10%) were among the most recurrent comorbidities. In total, 45 non-cardiac interventions were performed on 26 patients, with three bleeding complications and one death.
  
  
  CONCLUSIONS
  This study shows excellent long-term survival after both lateral tunnel and extracardiac conduit Fontan. The incidence of cardiovascular morbidity remains high, however. We also report a high number of non-cardiac interventions. Thorough understanding of the Fontan physiology is mandatory when non-cardiac anaesthesiologists are in charge of these patients.
authors.affiliation: 1Department of Anesthesiology;Université Catholique de Louvain,Cliniques Universitaires Saint Luc,Brussels,Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Palumbo
authors.affiliation: 2Department of Pediatric Cardiology;Université Catholique de Louvain,Cliniques Universitaires Saint Luc,Brussels,Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Sluysmans
authors.affiliation: 3Department of Cardiac Surgery;Université Catholique de Louvain,Cliniques Universitaires Saint Luc,Brussels,Belgium.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Rubay
authors.affiliation: 3Department of Cardiac Surgery;Université Catholique de Louvain,Cliniques Universitaires Saint Luc,Brussels,Belgium.
authors.forename: Alain J
authors.initials: AJ
authors.lastname: Poncelet
authors.affiliation: 1Department of Anesthesiology;Université Catholique de Louvain,Cliniques Universitaires Saint Luc,Brussels,Belgium.
authors.forename: Mona
authors.initials: M
authors.lastname: Momeni
mesh_terms: D000368:Aged; D000777:Anesthetics / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics
keywords: Fontan; long-term outcome; non-cardiac intervention