Long term prognosis of patients who had a Fontan operation

Kim, Hyun Jung; Bae, Eun Jung; Noh, Jung Il; Choi, Jung Yun; Yun, Yong Su; Kim, Wong Hwan; Lee, Jung Yeul; Kim, Yong Jin

Abstract

PURPOSE: This study assessed the long term survival rate and long term complications of patients who had a modified Fontan operation for functionally univentricular cardiac anomaly.
METHODS
Between June 1986 and December 2000, 302 patients with a functional single ventricle underwent surgical interventions and were followed up until February 2006. The mean follow-up period was 8.3+/-5.3 years (range 3.5-18 years). Their median age was 2.4 years at the Fontan operation. The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively.
RESULTS
The verall survival rate was 91 percent at 5 years and 87 percent at 10 years. In multivariate analysis, early calendar year of operation and significant regurgitation were risk factors of death. The surviving patients showed NYHA functional class I in 82 percent, class II in 15 percent, and class III in 3 percent. Redo Fontan operations were necessary in 8.8 percent of patients at average 12.8+/-3.6 years after initial Fontan operation. The most common cause of Fontan conversion was atrial arrhythmia. The incidence of thromboembolic events was 9.3% and these complications were associated with the occurrence of atrial tachyarrhythmia. Supraventricular tachycardia including atrial flutter or fibrillation were reported on the follow-up examination by 11.2 percent of survivors after 8.4+/-5.6 years. Atriopulmonary connection showed higher rates of late tachycardia than lateral tunnel operation.
CONCLUSIONS
This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.