Contemporary outcomes of the Fontan operation: a single-institution cohort from China.

BACKGROUND

The Fontan procedure is the established benchmark for palliating single-ventricle (SV) heart conditions. This study aimed to assess the midterm outcomes of Fontan operations (FOs), focusing on identifying contemporary risk factors for early mortality and Fontan failure.

METHODS

All patients who underwent FOs between 2005 and 2023 were divided into three cohorts: 2005-2010 (Era I), n=34; 2011-2017 (Era II), n=84; and 2018-2023 (Era III), n=55. These cohorts were categorized based on the surgical techniques employed. Multivariable logistic and Cox regression models were employed to identify potential risk factors.

RESULTS

The rates of patients undergoing intra-extracardiac (IE) conduit fenestrated Fontan procedures in the three eras were 0%, 4.8%, and 36.4%, respectively (P<0.001). The frequency of atrioventricular valve (AAV) surgery in Era III was significantly higher than that in Era I (14.5% vs. 5.9%, P=0.002). The IE groups exhibited significantly higher mean pulmonary artery pressures (mPAPs), longer stay in the cardiac care unit, and higher rates of late deaths. Early mortality rates were 18.6%, 4.8%, and 3.6%, respectively (P=0.02). Pulmonary atresia with ventricular septal defect or complete atrioventricular canal defect (PA/VSD/CAVC) [odds ratio (OR) =13.3; 95% confidence interval (CI): 2.8-63.9; P=0.001] and delayed sternal closure (DSC) (OR =5.1; 95% CI: 1.0-24.7; P=0.045) were independent risk factors for early mortality. History of valvular repair surgery [hazard ratio (HR) =3.3; 95% CI: 1.0-11.0; P=0.049], DSC (HR =3.5; 95% CI: 1.2-10.0; P=0.02), and intensive care unit (ICU) stay >1 week (HR =7.5; 95% CI: 2.4-23.4; P<0.001) were independent risk factors for Fontan failure.

CONCLUSIONS

The outcomes of FOs have improved significantly over the years, with a trend towards more frequent use of IE conduit fenestrated Fontan procedures and the management of increasingly complex diagnose.