title: Ten-year outcomes of Fontan conversion in Australia and New Zealand demonstrate the superiority of a strategy of early conversion.
abstract: OBJECTIVE
  To investigate the benefits of a strategy of early Fontan conversion.
  
  
  METHODS
  Using the Australia and New Zealand Fontan Registry, retrospective analysis of their long-term follow-up data was performed.
  
  
  RESULTS
  Between 1990 and 2014, a total of 39 patients underwent surgical conversion in 6 centres at a median age of 23.8 years (IQR: 19.3-28.2), 18.7 ± 5.0 years post-Fontan. One centre tended to perform conversion earlier: interval since first documented arrhythmia 2.9 ± 4.0 vs 4.0 ± 4.2 years, average NYHA Class 2 ± 0.4 vs 3 ± 0.9 (P = 0.008), mean number of preop anti-arrhythmics 1 ± 0.4 vs 2 ± 0.6 (P = 0.05). Two patients underwent conversion to an extracardiac conduit only, while 36 had concomitant right atrial cryoablation, of which 16 also had pacemaker implantation. Nine patients suffered major cardiac-related complications (7 low output syndrome, 3 ECMO, 3 acute renal failure, one stroke) (2/17 from the early conversion centre and 7/22 of the others; P = 0.14). Four patients died in hospital (10.3%) and 4 late after a median of 0.9 years [95% confidence interval (CI): 0.5-1] after conversion. An additional 2 patients needed transplantation at 1 and 8.8 years after conversion, respectively. The 10-year freedom from heart transplantation was 86% (95% CI: 51-97%). Outcomes from the centre with an early conversion strategy were significantly better: 8-year freedom from death or heart transplantation was 86% (95% CI: 53-96) vs 51% (95% CI: 22-74; log-rank P = 0.007). Eight additional patients required pacemaker implantation and 5 had arrhythmia recurrence.
  
  
  CONCLUSIONS
  Fontan conversion is associated with lasting survival outcomes up to 10 years after conversion. A strategy of surgical conversion at earlier stage of failure may be associated with better survival free from transplantation.
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Chin Leng
authors.initials: CL
authors.lastname: Poh
authors.affiliation: Department of Cardiothoracic Surgery, Monash Medical Centre, Monash University Faculty of Medicine, Melbourne, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cochrane
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia.
authors.forename: John C
authors.initials: JC
authors.lastname: Galati
authors.affiliation: Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bullock
authors.affiliation: Department of Medicine, The University of Sydney, Sydney, NSW, Australia Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Celermajer
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand.
authors.forename: Tom
authors.initials: T
authors.lastname: Gentles
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: du Plessis
authors.affiliation: Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: David S
authors.initials: DS
authors.lastname: Winlaw
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Hornung
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Finucane
authors.affiliation: Murdoch Children's Research Institute, Melbourne, VIC, Australia Department of Paediatrics, Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia The Royal Children's Hospital, Melbourne, VIC, Australia yves.dudekem@rch.org.au.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D055815:Young Adult
keywords: Atriopulmonary Fontan; Fontan conversion; Fontan procedure; Long-term outcomes