OBJECTIVES: The aim of this study was to evaluate Fontan peri-operative outcomes for 771 consecutive patients. BACKGROUND: Since the initial description by Fontan, mortality associated with the Fontan operation has declined substantially. However, postoperative effusions remain a significant challenge. Effusions are a key determinant of postoperative length-of-stay and have been shown to be associated with the development of protein-losing enteropathy and with decreased survival. METHODS: This study was a single-center, retrospective review of 771 patients who underwent Fontan palliation from 1992 to 2009. RESULTS: Patients were divided into 3 eras dictated by shift in clinical practice. Overall mortality was 3.5%, 1% since 1996. Importantly, age at Stage II palliation decreased from Era 1 to Era 3 (7.1 vs. 5.9 months; p = 0.0001), whereas age at Fontan increased (1.7 vs. 2.8 years; p = 0.0001). The proportion of patients with prolonged hospital stay (46.7% vs. 8.2% vs. 19.5%, p < 0.001) decreased substantially after Era 1. A diagnosis of hypoplastic left heart syndrome and longer operative support times were associated with prolonged pleural drainage (odds ratio [OR]: 2.17, p < 0.001; OR: 1.2, p = 0.001) and hospital stay (OR: 1.48, p = 0.05; OR: 1.34, p < 0.001). In patients who underwent invasive assessment, higher pulmonary artery pressure was associated with death (OR: 1.37, p < 0.001) and prolonged hospital stay (OR: 1.09, p = 0.019). Pulmonary arterial pressure ≥15 mm Hg was 90% specific for discriminating unfavorable outcomes. CONCLUSIONS: Mortality in the modern era is rare, whereas postoperative pleural drainage remains the dominant morbidity. Elevated pulmonary artery pressure seems to be a marker of unfavorable outcome. Continued investigation is warranted to determine whether medical interventions or alterations to operative strategy can alter peri-operative results and improve long-term outcomes.
OBJECTIVES: The aim of this study was to evaluate Fontan peri-operative outcomes for 771 consecutive patients. BACKGROUND: Since the initial description by Fontan, mortality associated with the Fontan operation has declined substantially. However, postoperative effusions remain a significant challenge. Effusions are a key determinant of postoperative length-of-stay and have been shown to be associated with the development of protein-losing enteropathy and with decreased survival. METHODS: This study was a single-center, retrospective review of 771 patients who underwent Fontan palliation from 1992 to 2009. RESULTS:Patients were divided into 3 eras dictated by shift in clinical practice. Overall mortality was 3.5%, 1% since 1996. Importantly, age at Stage II palliation decreased from Era 1 to Era 3 (7.1 vs. 5.9 months; p = 0.0001), whereas age at Fontan increased (1.7 vs. 2.8 years; p = 0.0001). The proportion of patients with prolonged hospital stay (46.7% vs. 8.2% vs. 19.5%, p < 0.001) decreased substantially after Era 1. A diagnosis of hypoplastic left heart syndrome and longer operative support times were associated with prolonged pleural drainage (odds ratio [OR]: 2.17, p < 0.001; OR: 1.2, p = 0.001) and hospital stay (OR: 1.48, p = 0.05; OR: 1.34, p < 0.001). In patients who underwent invasive assessment, higher pulmonary artery pressure was associated with death (OR: 1.37, p < 0.001) and prolonged hospital stay (OR: 1.09, p = 0.019). Pulmonary arterial pressure ≥15 mm Hg was 90% specific for discriminating unfavorable outcomes. CONCLUSIONS: Mortality in the modern era is rare, whereas postoperative pleural drainage remains the dominant morbidity. Elevated pulmonary artery pressure seems to be a marker of unfavorable outcome. Continued investigation is warranted to determine whether medical interventions or alterations to operative strategy can alter peri-operative results and improve long-term outcomes.
Authors: Katherine E Bates; Nicolas L Madsen; Lara Khadr; Zhiqian Gao; Kari Crawford; Michael Gaies; Margaret Graupe; Samuel P Hanke; Anthony M Hlavacek; Evonne Morell; Sara K Pasquali; Jennifer L Russell; Susan K Schachtner; Ronn E Tanel; Adam L Ware; Alaina K Kipps Journal: Ann Thorac Surg Date: 2019-11-21 Impact factor: 4.330
Authors: Abhay Srinivasan; Anthony K Guzman; Elizabeth B Rand; Jack Rychik; David J Goldberg; Pierre A Russo; Anne Marie Cahill Journal: Pediatr Radiol Date: 2018-11-30
Authors: Chitra Ravishankar; Eric Gerstenberger; Lynn A Sleeper; Andrew M Atz; Jeremy T Affolter; Timothy J Bradley; J William Gaynor; Bryan H Goldstein; Heather T Henderson; Jeffrey P Jacobs; Alan B Lewis; Carolyn Dunbar-Masterson; Shaji C Menon; Victoria L Pemberton; Christopher J Petit; Nancy A Pike; Christian Pizarro; Kurt R Schumacher; Ismee A Williams; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2015-09-28 Impact factor: 5.209
Authors: Stephanie A Goldstein; Asaad G Beshish; Lauren B Bush; Ray E Lowery; Joshua H Wong; Kurt R Schumacher; Nadine L N Halligan; Timothy T Cornell; Albert P Rocchini Journal: Pediatr Cardiol Date: 2019-02-01 Impact factor: 1.655