title: Can Fontan Conversion for Patients Without Late Fontan Complications be Justified?
abstract: BACKGROUND
  Fontan conversion from a classic Fontan operation such as atriopulmonary connection to total cavopulmonary connection with antiarrhythmia surgery is currently not indicated for patients without any late Fontan complications.
  
  
  METHODS
  Thirty-two consecutive patients who underwent Fontan conversion between 1991 and 2012 were divided into 2 groups by the presence (group 1: n = 25, atrial tachyarrhythmia [AT] in 24 and protein-losing enteropathy in 4) or absence (group 2: n = 7) of late Fontan complications, and the surgical outcomes were retrospectively compared. During the study period, heart transplantation was not indicated for patients with failed Fontan circulation in Japan.
  
  
  RESULTS
  The mean follow-up period was 6.2 ± 3.7 years in group 1 and 4.6 ± 3.8 years in group 2 (p = 0.29). Overall survival rate at 10 years after conversion was 71% in group 1 and 100% in group 2 (p = 0.12). Whereas preoperative AT and protein-losing enteropathy remained after conversion in 8 patients (33%) and all 4 patients (100%), respectively, in group 1, neither were observed in group 2. Cardiac catheter examinations presurgery (n = 32) at 1 year (n = 28), and at 5 years (n = 19) after the conversion showed that the cardiac index significantly and similarly improved in both groups after the conversion, and maintained for at least 5 years.
  
  
  CONCLUSIONS
  Cardiac output similarly improved after Fontan conversion in patients with or without late Fontan complications by elimination of venous blood congestion on Fontan pathways. Although long-term follow-up is mandatory, newly onset AT was not observed after prophylactic Fontan conversion.
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Higashida
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: thoashi@surg1.med.osaka-u.ac.jp.
authors.forename: Takaya
authors.initials: T
authors.lastname: Hoashi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kagisaki
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Shimada
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohuchi
authors.affiliation: Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Shiraishi
authors.affiliation: Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ichikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007564:Japan; D008297:Male; D011183:Postoperative Complications; D011504:Protein-Losing Enteropathies / Q000209:etiology*; D012086:Reoperation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult