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Risk Factors for Failed Fontan Procedure After Stage 2 Palliation.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2021 Aug; Vol. 112 (2), pp. 610-618. Date of Electronic Publication: 2020 Aug 20. - Publication Year :
- 2021
-
Abstract
- Background: Our aim was to evaluate the results of stage 2 palliation by means of bidirectional cavopulmonary shunt (BCPS) and to identify risk factors for failed Fontan completion.<br />Methods: Between 1998 and 2018, BCPS was performed on 525 patients with functional single ventricle. Patient demographics, surgical data, and echocardiographic and cardiac catheterization measurements were analyzed, and outcomes after BCPS were evaluated.<br />Results: The median age at BCPS was 4.7 months (interquartile range, 3 to 7.4). Hypoplastic left heart syndrome was the most frequent diagnosis. The median follow-up after BCPS was 3.4 years (interquartile range, 1.5 to 8.7); 407 patients underwent the Fontan procedure, 50 were waiting for Fontan completion, 47 died, 6 were considered not suitable for Fontan completion, and 15 were lost to follow-up. Of the 407 patients who underwent Fontan completion, there were 5 early deaths. Freedom from failed Fontan completion (mortality before, unsuitability for, and early mortality after the Fontan procedure) at 1, 2, and 3 years was 91.9%, 87.3%, and 86.1%, respectively. Risk factor analysis for failed Fontan completion revealed hypoplastic left heart syndrome (hazard ratio [HR] 4.1, P = .001), unbalanced atrioventricular septal defect (HR 10.1, P < .001), higher pulmonary artery pressure (HR 1.1, P = .040), and reduced ventricular function (HR 4.2, P = .001) as risks.<br />Conclusions: Stage 2 palliation can be performed with minimal risk and provides excellent subsequent Fontan completion. Hypoplastic left heart syndrome, unbalanced atrioventricular septal defect, high pulmonary artery pressure, and reduced ventricular function at the time of BCPS were identified as risk factors for failure to successfully complete the Fontan procedure.<br /> (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Child
Child, Preschool
Echocardiography
Female
Follow-Up Studies
Heart Septal Defects diagnosis
Heart Ventricles diagnostic imaging
Humans
Hypoplastic Left Heart Syndrome diagnosis
Male
Reoperation
Retrospective Studies
Treatment Outcome
Cardiac Catheterization methods
Fontan Procedure methods
Heart Septal Defects surgery
Heart Ventricles surgery
Hypoplastic Left Heart Syndrome surgery
Palliative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 112
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32828751
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2020.06.030