title: Conversion to Total Cavopulmonary Connection Improves Functional Status Even in Older Patients with Failing Fontan Circulation.
abstract: BACKGROUND
  Facing longer follow-up of patients after Fontan operation, Fontan conversion was proposed to treat failing Fontan circulation. We reviewed our patients who reached up to 42 years of age.
  
  
  METHODS
  Fifteen consecutive patients underwent Fontan conversion to extracardiac conduit combined with biatrial maze procedure between October 2006 and January 2014. Mean age at conversion was 30.9 ± 5.6 years and mean interval from primary Fontan palliation to conversion was 23.2 ± 3.3 years.
  
  
  RESULTS
  There was one early death. Ten of 14 survivors were extubated within 24 hours, and 11 were discharged from intensive care unit (ICU) within 7 days. The impaired left ventricular function, presented in four patients prior to surgery, improved from EF 43.8 to 54.8% (p = 0.02). During follow-up time of 3.6 ± 2.3 years after conversion, there was no late death and no reoperation. Two patients developed recurrent atrial arrhythmia. Older age at Fontan procedure, lower left ventricular function, higher New York Heart Association (NYHA) class, and anatomy other than tricuspid atresia emerged as risk factors for longer ICU stay.
  
  
  CONCLUSIONS
  Fontan conversion improved the functional status in almost all patients. A concomitant maze procedure effectively eliminated atrial arrhythmia. This procedure provides a benefit even for older patients if all additional cardiac pathologies are addressed.
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Masamichi
authors: M
authors: Ono
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Julie
authors: J
authors: Cleuziou
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Jelena
authors: J
authors: Kasnar-Samprec
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Melchior
authors: M
authors: Burri
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Vanessa
authors: V
authors: Hepp
authors: Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University, Munich, Germany.
authors: Manfred
authors: M
authors: Vogt
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Rüdiger
authors: R
authors: Lange
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Christian
authors: C
authors: Schreiber
authors: Department of Cardiovascular Surgery, German Heart Center Munich, Technical University, Munich, Germany.
authors: Jürgen
authors: J
authors: Hörer
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000601:surgery*; D055815:Young Adult