The Clinical Outcome of Patients Undergoing Fontan Surgery; Over 10 Years of Experience in a Single Center

Abstract

Background: The modified Fontan operation is one of the essential surgical techniques in children with congenital heart diseases. Therefore, we sought to identify the characteristics as well as the early and late outcomes of patients who have undergone Fontan operation during more than 10 years. Methods: This study was conducted with a cross-sectional design. The medical records of 52 patients who underwent modified Fontan operation from March 21th, 2006 to March 20th, 2018, at Tabriz Children's Hospital including the bassline, clinical and surgical data were extracted retrospectively reviewed. Patients were invited for follow up visits and clinical examination and echocardiographic evaluations were conducted. Findings: The most prevalent heart anomaly was tricuspid valve disorders (28 cases, 51.9%). The majority of patients (42 cases, 80.2 %) underwent intracardiac lateral tunnel Fontan. The most prevalent complications were prolonged pleural effusion and neurologic events (each one in 10 cases, 19.2%). The in-hospital mortality rate was 15.3%. The patients were followed for a median 7 years. The survival of those successfully followed was 74.5 percent in 5 years. The most common valvular disorder was mitral valve regurgitation (MR), which was present in 84% of cases. The group of patients with single ventricle had a significantly higher mortality rate than the other groups (P = 0.018). Conclusion: The clinical data of patients who have undergone Fontan surgery was reviewed. Despite acceptable survival, patients remain at risk for morbid events in particular prolonged pleural effusion and neurologic events. Moreover, patients with Fontan circulation should be strictly followed to investigate the development of MR and to timely repair in severe cases to prevent further deterioration. Of note, due to some limitations of our study, further multi-centric studies are warranted to confirm our findings.