Medium and Long-Term Outcomes of Fontan Operation
Paweena Chungsomprasong MD*, Jarupim Soongswang MD*, Apichart Nana MD*, Kritvikrom Durongpisitkul MD*, Daungmanee Loahaprasitiporn MD*, Chodchanok Vijansorn MD*, Somchai Sriyodchartti MD**
Affiliation : * Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The Fontan operation had been proposed as the final palliative surgery in the patients with single ventricle
physiology. Even though modifications of the operation were developed to improve outcomes, long-term complications
remain significant with time. The present study reviewed long-term survival rate, morbidities associated with time, and risk
factors during the follow-up period after Fontan operation.
Material and Method: A retrospective study was conducted. Every patient who underwent the Fontan operation at Siriraj
Hospital between January 1987 and December 2007 and had available data was included in the present study. The data was
collected until the most recent follow-up in December 2008. Demographic data, diagnosis, echocardiographic data, cardiac
catheterization data, surgical data, type of modified Fontan procedure, and perioperative data were collected. The follow-up
clinical data, cardiac investigation data, complications, and management were also collected and analyzed.
Results : Survival rates were 88.7%, 85.3%, and 83.8% at 1 year, 5 years, and 10 years, respectively. The median follow-up
time was 4.75 years (0-17.45). The 10-years survival rate of tricuspid atresia, single ventricle and the heterotaxy syndrome
were 94.5%, 79%, and 83.3%, respectively, which were not significantly different (p = 0.09). The 10-years survival rates of
the patients that underwent lateral tunnel, extracardiac conduit and atriopulmonary connection were 80.7%, 88% and
84.3%, respectively. A mean pulmonary artery pressure of more than 18 mmHg was the only factor that affected the survival
rate after Fontan surgery (p = 0.008). The incidence of postoperative arrhythmia was 7.9%. Age at operation, diagnosis, type
of operation, fenestration, systemic EDP, or PVR before operation did not significantly affect the survival rate. Diagnosis and
type of surgery did not affect long-term outcome regarding arrhythmia, re-intervention, systemic atrioventricular valve
regurgitation, and systemic ventricular dysfunction. Patients post Fontan operation had good survival rate.
Conclusion : Cardiac diagnoses were not significantly different in the medium and long-term survival rate of post Fontan
patients, freedom from arrhythmia, re-intervention and systemic atrioventricular regurgitation. Types of Fontan operation
did not affect long-term survival rate or long-term complications. Mean pulmonary artery pressure of more than 18 mmHg
was the only risk factor to the survival rate.
Keywords : Fontan operation, Outcome, Complication
