Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology · 2025
20 years of experience with the Fontan procedure: Risk factors for adverse outcomes.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chen Tianyu, Han Linjiang, Qiu Hailong, Chen Zewen, Cen Jianzheng, Wen Shusheng, Chen Jimei, Liu Xiaobing, Zhuang Jian
Аннотация
INTRODUCTION AND OBJECTIVES: The Fontan procedure and the management of patients with univentricular physiology have undergone significant evolution over the past five decades. However, the long-term outcomes of these patients remain not fully understood. This study aimed to evaluate the early and long-term outcomes of patients undergoing the Fontan procedure and to identify risk factors associated with adverse clinical events.
METHODS: Patients who underwent the Fontan procedure between 2004 and 2023 were included in this study. Multivariable logistic regression analysis was employed to assess risk factors for early mortality, while a Cox proportional hazards regression model was used to evaluate predictors of long-term Fontan failure.
RESULTS: A total of 400 patients were included, with a male predominance (67.3%). Median age at the time of the Fontan procedure was 5.8 years (interquartile range: 4.1-11.0 years). The distribution of ventricular morphology was as follows: dominant right ventricle (33%), dominant left ventricle (35.75%), and two well-developed ventricles (28.75%). The early mortality rate was 5.5%. The overall survival rates at 5-, 10-, and 15-years post-Fontan surgery were 97.5%, 92.6%, and 90.0%, respectively. Multivariable analysis identified asplenia (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.8-36.4; p<0.01), single-stage total cavopulmonary connection (OR, 5.3; 95% CI, 1.7-16.8; p<0.01), and prolonged cardiopulmonary bypass time (OR, 1.0; 95% CI, 1.0-1.0; p<0.01) as significant predictors of early mortality. Cox regression analysis demonstrated that heterotaxy (hazard ratio [HR], 3.5; 95% CI, 1.4-8.7; p<0.01) was an independent risk factor for late Fontan failure.
CONCLUSION: The staged Fontan strategy was associated with reduced early mortality but did not confer significant benefits on long-term outcomes. Patients with heterotaxy were at an increased risk of late Fontan failure, highlighting the need for tailored management strategies in this high-risk population.
METHODS: Patients who underwent the Fontan procedure between 2004 and 2023 were included in this study. Multivariable logistic regression analysis was employed to assess risk factors for early mortality, while a Cox proportional hazards regression model was used to evaluate predictors of long-term Fontan failure.
RESULTS: A total of 400 patients were included, with a male predominance (67.3%). Median age at the time of the Fontan procedure was 5.8 years (interquartile range: 4.1-11.0 years). The distribution of ventricular morphology was as follows: dominant right ventricle (33%), dominant left ventricle (35.75%), and two well-developed ventricles (28.75%). The early mortality rate was 5.5%. The overall survival rates at 5-, 10-, and 15-years post-Fontan surgery were 97.5%, 92.6%, and 90.0%, respectively. Multivariable analysis identified asplenia (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.8-36.4; p<0.01), single-stage total cavopulmonary connection (OR, 5.3; 95% CI, 1.7-16.8; p<0.01), and prolonged cardiopulmonary bypass time (OR, 1.0; 95% CI, 1.0-1.0; p<0.01) as significant predictors of early mortality. Cox regression analysis demonstrated that heterotaxy (hazard ratio [HR], 3.5; 95% CI, 1.4-8.7; p<0.01) was an independent risk factor for late Fontan failure.
CONCLUSION: The staged Fontan strategy was associated with reduced early mortality but did not confer significant benefits on long-term outcomes. Patients with heterotaxy were at an increased risk of late Fontan failure, highlighting the need for tailored management strategies in this high-risk population.