Reoperations after Fontan Procedures

Lee, Cheul; Kim, Yong Jin; Lee, Jeong Ryul; Rho, Joon Ryang

Abstract

BACKGROUND: Surgical results of the Fontan procedures in patients with a single ventricle have improved. As the perioperative mortality continues to decline and late outcome is forthcoming, attention is now being directed toward late complications of the Fontan procedures. We retrospectively analyzed our experience with reoperations after Fontan procedures. MATERIAL AND METHOD: Between January 1988 and December 2002, 24 patients underwent reoperations after Fontan procedures. The median age at Fontan procedures and reoperation was 3.3 years and 9.2 years, respectively. Types of initial Fontan procedures were atriopulmonary connection (n=11), lateral tunnel Fontan (n=11), and extracardiac conduit Fontan (n=2). Indications for reoperation included atrioventricular valve regurgitation (n=7), atrial arrhythmia (n=8), Fontan pathway stenosis (n=7), residual right-to-left shunt (n=5), etc. RESULT: Procedures performed at reoperation included atrioventricular valve replacement (n=6), conversion to lateral tunnel Fontan (n=5), conversion to extracardiac conduit Fontan (n=3), cryoablation of arrhythmia circuit (n=7), etc. There was no operative mortality. There were 2 late deaths. Mean follow-up duration was 2.7+/-2.1 years. All patients except two were in NYHA class I at the latest follow-up. Among 8 patients with preoperative atrial arrhythmia, postoperative conversion to normal sinus rhythm was achieved in 7 patients.
CONCLUSION
Reoperations after Fontan procedures could be achieved with low mortality and morbidity. Reoperation may lead to clinical improvement in patients with specific target conditions such as atrioventricular valve regurgitation, refractory atrial arrhythmia, or Fontan pathway stenosis, especially in patients with previous atriopulmonary connection.