Early outcomes of children with univentricular circulation undergoing Fontan surgery: the EuroFontan registry.
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Padalino Massimo A, Constantine Andrew, Bergonzoni Emma, Cao Irene, Horer Jurgen, Ono Masamichi, Staehler Helena, Sames-Dolzer Eva, Gierlinger Gregor, Hazekamp Mark, Rijnberg Friso M, Galletti Lorenzo, Butera Gianfranco, Panebianco Mario, Meyns Bart, Van Puyvelde Joeri, Yemets Illya, Bairamov Elshad, Kansy Andrzej, Nosal Matej, Lenoir Marien, Angeli Emanuela, Careddu Lucio, Martens Thomas, Bove Thierry, Napoleone Carlo Pace, Lo Rito Mauro, Giamberti Alessandro, Montanaro Claudia, Marianeschi Stefano, Agati Salvatore, Sarris George K, Protopapas Eleftherios, Rocafort Alvaro Gonzalez, Scrascia Giuseppe, Meliota Giovanni, Vairo Ugo, Michielon Guido, Gozzi Anna, Biffanti Roberta, Castaldi Biagio, Gregori Dario, Vedovelli Luca, Di Salvo Giovanni, Vida Vladimiro, Dimopoulos Konstantinos
Аннотация
METHODS: The EuroFontan registry is a multicentre retrospective study involving 21 congenital heart disease and transplant centres across Europe. Data were collected on patients who underwent Fontan surgery from January 1990 to January 2023. Analyses focused on the most recent 15-year period. A composite early adverse outcome (death within 30 days or in-hospital, low cardiac output syndrome, stroke, or Fontan takedown) was used. Predictors were assessed using multivariable mixed-effects logistic regression, with centre included as a random effect. Missing data were handled using multiple imputation with Rubin's rules, and sensitivity analyses were performed to assess robustness.
RESULTS: Of 3510 patients, this analysis focused on 2075 individuals from the past 15 years, with a median age of 4.2 [interquartile range 3.2-6.2] years at Fontan completion. Early mortality was 1.0% (95% confidence interval .66%-1.54%). The composite adverse outcome occurred in 5.1% (95% confidence interval 4.2%-6.1%). On multivariable analysis, morphology other than tricuspid atresia was the only significant predictor of the composite outcome (odds ratio 2.2, 95% confidence interval 1.21-3.99, P = .01).
CONCLUSIONS: Fontan surgery has evolved and, in contemporary practice, has low peri-operative morbidity and mortality. Morphology other than tricuspid atresia was associated with increased risk of early adverse outcomes, highlighting the importance of pre-operative risk stratification.