Analysis of Risk Factors and Outcomes of Fontan Procedure in Single Ventricular Repair: A Retrospective Observational Study

Abstract

Introduction: The Fontan operation is a surgical technique used to treat cyanotic heart diseases with single ventricle physiology. Although it has undergone several modifications since its inception in 1971, it is still associated with significant morbidity and mortality. Aim: To examine the outcomes of the Fontan operation and identify various risk factors associated with it. Materials and Methods: This retrospective observational study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India from January 2014 to December 2017. All patients who underwent the Fontan operation at PGIMER were included in the study. The study analysed outcomes such as survival, arrhythmias, neurological complications, heart failure, cirrhosis, and Protein Losing Enteropathy (PLE) following the Fontan operation. Various risk factors that could potentially influence the outcome of the Fontan operation were assessed, including preoperative, intraoperative, and postoperative factors. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0. The Chi-square test was utilised to determine predictors of survival and other longterm outcomes, with a p-value of <0.05 considered statistically significant. Results: A total of 35 patients underwent the Fontan operation during the study period and completed five years of follow-up. Out of these, 28 were known to be alive at the last contact. There were six early deaths (less than one year). The overall oneyear and five-year survival rates from the time of the operation were 29 (83%) and 28 (80%), respectively. Graft thrombosis/ thromboembolism was observed in three cases (8.6%) and neurological complications in three cases (8.6%) during the early postoperative period. Arrhythmias in 6 cases (14%) were the most common late postoperative complication. Conclusion: The Fontan procedure is currently the best available palliative treatment for cyanotic heart diseases with single ventricle physiology. Patient selection is crucial in this procedure, as the presence of risk factors may adversely affect the outcome.