Back to Search
Start Over
Long-term outcomes following Fontan takedown in Australia and New Zealand.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2021 Mar; Vol. 161 (3), pp. 1126-1135. Date of Electronic Publication: 2020 Oct 06. - Publication Year :
- 2021
-
Abstract
- Objective: Fontan takedown remains an option for the management of Fontan failure. We sought to evaluate early and late outcomes after Fontan takedown.<br />Methods: The Australia and New Zealand Fontan Registry was interrogated to identify all patients who had a Fontan takedown.<br />Results: Over a 43-year study period (1975-2018), 36 of 1540 (2.3%) had a Fontan takedown. The median age at takedown was 5.1 years (interquartile range [IQR], 3.7, 7.0). Nine (25%) patients had a takedown within 48 hours, 6 (16%) between 2 days and 3 weeks, 14 (39%) between 3 weeks and 6 months, whereas 7 (19%) had a late takedown (>6 months). Median interval to takedown was 26 days (IQR, 1.5, 127.5). Sixteen (44%) patients died at a median of 57.5 days (IQR, 21.8, 76.8). The greatest mortality occurred between 3 weeks and 6 months (<2 days: 1/9, 11%; 2 days to 3 weeks: 2/6, 33%; 3 weeks to 6 months: 11/14, 79%; >6 months: 2/7, 28%; P = .007). At median follow-up of 9.4 years (IQR, 4.5, 15.3), 11 (31%) patients were alive with an intermediate circulation (10 in New York Heart Association class I/II). Five (14%) patients underwent a successful second Fontan. Freedom from death/transplant after Fontan takedown was 59%, 56%, and 52% at 1, 5, and 10 years, respectively.<br />Conclusions: The incidence of Fontan takedown is low, but mortality is high. The majority of takedowns occurred within 6 months. Mortality was lowest when takedown occurred <2 days and highest between 3 weeks and 6 months. A second Fontan is possible in a small proportion of survivors.<br /> (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Australia
Child
Child, Preschool
Female
Fontan Procedure mortality
Heart Defects, Congenital mortality
Heart Defects, Congenital physiopathology
Hemodynamics
Humans
Male
New Zealand
Recovery of Function
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Fontan Procedure adverse effects
Heart Defects, Congenital surgery
Reoperation adverse effects
Reoperation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 161
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 33131894
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2020.09.074