Lateral Tunnel Fontan vs Extracardiac Conduit Early Outcomes: A Study of The Society of Thoracic Surgeons Congenital Heart Surgery Database.

BACKGROUND

We intended to identify whether the lateral tunnel (LT) and extracardiac conduit (ECC) Fontan provide similar short-term outcomes in contemporary data.

METHODS

Patients in The Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent a primary LT or ECC from 2012 to 2022 were included. Hospital mortality, 30-day readmission, and complications were investigated.

RESULTS

There were 11,429 Fontan procedures performed in 133 centers: 2012 LT (18%) and 9417 ECC (82%). Only 3% of surgeons (n = 9) were exclusively performing LT, whereas 57% (n = 190) were exclusively performing ECC, and 40% (n = 132) were using both techniques. Similarly, only 1 hospital performed LT exclusively, whereas 50 (37%) performed the ECC, and 82 (62%) used both techniques. The age at the time of the Fontan surgery was younger in the LT group (P < .001). Fenestration was made in 85% of patients with LT and in 57% of patients with ECC (P < .001). The operative mortality (1.1% for LT vs 1.3% for ECC; P = .49) was similar. Patients undergoing ECC had higher rate of 30-day readmission (1445 [18%] vs 220 [14%]; P < .001), prolonged length of stay >30 days (583 [6%] vs 78 [4%]; P < .001), pleural effusion requiring drainage (1147 [17%] vs 140 [13%], P < .001), chylothorax (864 [13%] vs 98 [9%]; P < .001), and stroke (117 [1.8%] vs 9 [0.9%]; P = .03).

CONCLUSIONS

The LT Fontan has similar mortality and lower short-term complication rates than the ECC Fontan, but the latter has become the most frequently performed technique.