The Annals of thoracic surgery · 2026
Long-term Outcomes after Fontan Single Ventricle Palliation: A Systematic Review and Meta-Analysis of Regional Registry Data.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Zoupas Ioannis, Kim Stephanie, Dobrila Julija, Cruz Julieta, Mills Alexander C, Bauser-Heaton Holly D, Prada-Ruiz Adriana Carolina, Chen Peter C, Greenleaf Christopher E, LaPar Damien J
Аннотация
BACKGROUND: While several Fontan patient registries have been established, a systematic analysis of these collective data does not exist to provide insight into long-term outcomes. This meta-analysis aims to provide an updated assessment of published Fontan patient outcomes.
METHODS: A systematic search identified registry studies reporting long-term outcomes following the Fontan procedure. A reconstructed individual patient data-based meta-analysis assessed survival and failure rates. Subgroup analyses evaluated outcomes across different Fontan techniques.
RESULTS: Six registry studies, including 7,854 Fontan patients, were included. The mean age at Fontan completion was 5.8 years, with a mean follow-up age of 21.4 years. 58.7% of patients were male. An extracardiac conduit (ECC) was used in 62.1% of patients, a lateral tunnel (LT) in 23.1%, and the atriopulmonary (AP) technique in 14.8%. 5.1% of patients underwent early surgical revision. Cumulative survival rates were 93.6% at 10 years, 87.2% at 20 years, and 80.2% at 30 years. Upon comparison, both ECC and LT were associated with significantly improved survival compared to the AP technique (p<0.001). Finally, freedom-from-Fontan-failure rates at 10, 20, and 30 years of follow-up were 76.6%, 74.9%, and 70.2%, respectively.
CONCLUSIONS: These data demonstrate that Fontan palliation yields better long-term survival than previously reported. ECCs are most common, and both ECC and LT techniques outperform the AP technique. These data provide important context for patient counseling regarding expected long-term outcomes after single-ventricle palliation and underscore the need for lifelong specialized surveillance in this population.
METHODS: A systematic search identified registry studies reporting long-term outcomes following the Fontan procedure. A reconstructed individual patient data-based meta-analysis assessed survival and failure rates. Subgroup analyses evaluated outcomes across different Fontan techniques.
RESULTS: Six registry studies, including 7,854 Fontan patients, were included. The mean age at Fontan completion was 5.8 years, with a mean follow-up age of 21.4 years. 58.7% of patients were male. An extracardiac conduit (ECC) was used in 62.1% of patients, a lateral tunnel (LT) in 23.1%, and the atriopulmonary (AP) technique in 14.8%. 5.1% of patients underwent early surgical revision. Cumulative survival rates were 93.6% at 10 years, 87.2% at 20 years, and 80.2% at 30 years. Upon comparison, both ECC and LT were associated with significantly improved survival compared to the AP technique (p<0.001). Finally, freedom-from-Fontan-failure rates at 10, 20, and 30 years of follow-up were 76.6%, 74.9%, and 70.2%, respectively.
CONCLUSIONS: These data demonstrate that Fontan palliation yields better long-term survival than previously reported. ECCs are most common, and both ECC and LT techniques outperform the AP technique. These data provide important context for patient counseling regarding expected long-term outcomes after single-ventricle palliation and underscore the need for lifelong specialized surveillance in this population.