P0339 / #936: HIGH RISK FONTAN: A SINGLE CENTER EXPERIENCE IN A MIDDLE INCOME COUNTRY

Abstract

Aims & Objectives: Patients after Fontan operations are affected by a numerous of complications related to the increased venous pressure. The purpose of this study was to describe adverse events during the early postoperative period as to identify risk factors for a prolonged PICU stay and mortality in a single center in Mexico. Methods: This was a retrospective study. Between 2008 and 2018, we evaluated data of pediatric patients who underwent Fontan procedure to identify variables associated with morbidity and mortality. Results: We had 133 patients with a mean age of 8 years, 111 (84%) of them had previous procedures. Although all patients meet Fontan criteria, almost 85% of them showed some level of pulmonary branch distortion that required surgical intervention. The most common procedure was fenestrated extracardiac conduit in 95.5% and the mean PICU stay was 6.8 days. The most frequent morbidity was pleural effusions, 91.9% present bilateral effusions and in 37.4% persisted for more than 15 days. In 54 patients with hemodynamic instability a diagnostic catheterization was indicated, 48 patients required an intervention. Seventeen patients die (12.5%) and 7 Fontan takedowns were performed, considering the lack of transplant and ventricular assistant device programs in patients with univentricular physiology. Conclusions: Age, weigh and height at the time of the surgery, as a fenestration of 5 mm or smaller in the conduit, were the relevant factors associated with prolonged pleural effusions and poorer outcomes. Probably, late diagnosis and referral of patients to cardiac centers are the reasons of the important prevalence of high-risk Fontan patients.