title: Outcomes of Fontan conversion for failing Fontan circulation: mid-term results.
abstract: We investigated the results of a revision of a previous Fontan connection to total cavopulmonary connection (TCPC) in patients with failing Fontan circulation.
  
  
  
  From July 1998 to April 2013, 21 patients who had failing Fontan circulation underwent revision of the previous Fontan operation to TCPC. The median age at TCPC conversion was 17.9 years (range, 4.6-38.1 years) and the median interval between initial Fontan operation and TCPC was 13.8 years (range, 2.1-25.4 years). There were 37 indications for Fontan revision in 21 patients. The indications were huge right atrium (n = 15), atrial arrhythmia (n = 8), intra-atrial thrombi (n = 6), protein-losing enteropathy (PLE) (n = 3) and more than mild atrioventricular valve regurgitation (n = 5). The previous Fontan operation was revised to extracardiac conduit replacement (n = 20) and intra-atrial lateral tunnel (n = 1). Concomitant surgery for atrial arrhythmia was performed in 8 patients. Fenestration was performed in 7 patients. The median follow-up duration was 7.1 years (range, 0.3-13.4 years).
  
  
  
  There were no operative deaths and two late deaths occurred 7.9 and 8.1 years after operation. Actuarial 5- and 10-year survival rates were 92.3 and 83.1%, respectively. Postoperative complications included bleeding (n = 3), deep sternal infection (n = 1) and prolonged pleural effusion for more than 2 weeks (n = 5). During follow-up, atrial arrhythmia recurred in 6 patients, PLE recurred in 2 patients and pleural effusion recurred in 2 patients. All patients were classified as New York Heart Association Class I (n = 15) or Class II (n = 4).
  
  
  
  Fontan conversion to TCPC in patients with failing Fontan circulation can be performed with low risk of morbidity and mortality. The procedure confers better quality of life and is functional for patients with failed Fontan circulation.
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Han Ki
authors.initials: HK
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea babymedi@naver.com.
authors.forename: Hong Ju
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D012769:Shock / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Fontan operation