Abstract
There are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the Fontan operation. All 773 patients who underwent Fontan at our institution between 1992 and 2009 were retrospectively reviewed. Current information regarding post-Fontan intervention was available for 70%. By 20 years after Fontan, 65% of patients had experienced either surgical or transcatheter intervention. The median time to first reintervention was 9.8 years. Freedom from reoperation was 69% at 15 years and 63% at 20 years. The most common operations were pacemaker placement and Fontan revision. Risk factors for pacemaker placement included systemic left ventricle (hazard ratio [HR], 2.2; P=0.006) and lateral tunnel Fontan (HR, 4.3; P=0.001). Freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. The most common procedures performed were fenestration closure and pulmonary artery intervention. Catheter intervention for anatomic indications was associated with Fontan after 2002 (HR, 2.1; P=0.007), Norwood operation (HR, 2.3; P=0.001), and longer cardiopulmonary bypass time (HR, 1.1 per 10 minutes; P=0.001). Catheter intervention for physiological indications was associated with prolonged post-Fontan pleural drainage (HR, 4.0; P<0.001) and hypoplastic left heart syndrome (hr, 2.0; p="0.01)." in this study of fontan survivors, two thirds of patients required surgical or catheter-based reintervention by 20 years. families should be counseled that the fontan is typically not the final stage of single-ventricle palliation. there are limited follow-up studies examining surgical and catheter-based reinterventions in long-term survivors of the fontan operation. all 773 patients who underwent fontan at our institution between 1992 and 2009 were retrospectively reviewed. current information regarding post-fontan intervention was available for 70%. by 20 years after fontan, 65% of patients had experienced either surgical or transcatheter intervention. the median time to first reintervention was 9.8 years. freedom from reoperation was 69% at 15 years and 63% at 20 years. the most common operations were pacemaker placement and fontan revision. risk factors for pacemaker placement included systemic left ventricle (hazard ratio [hr], 2.2; p="0.006)" and lateral tunnel fontan (hr, 4.3; p="0.001)." freedom from interventional catheterization was 53% at 15 years and 50% at 20 years. the most common procedures performed were fenestration closure and pulmonary artery intervention. catheter intervention for anatomic indications was associated with fontan after 2002 (hr, 2.1; p="0.007)," norwood operation (hr, 2.3; p="0.001)," and longer cardiopulmonary bypass time (hr, 1.1 per 10 minutes; p="0.001)." catheter intervention for physiological indications was associated with prolonged post-fontan pleural drainage (hr, 4.0; p><0.001) and hypoplastic left heart syndrome (hr, 2.0; p="0.01)." in this study of fontan survivors, two thirds of patients required surgical or catheter-based reintervention by 20 years. families should be counseled that the fontan is typically not the final stage of single-ventricle palliation.>
