Late outcome of extracardiac Fontan patients: 32 years of follow-up

Autor:	Salvatore Giannico, Matteo Trezzi, Nicoletta Cantarutti, Giulia Cafiero, Lucilla Ravà, Rachele Adorisio, Gianluca Brancaccio, Sonia Albanese, Fabrizio Drago, Adriano Carotti, Antonio Amodeo, Lorenzo Galletti
Rok vydání:	2022
Předmět:	Heart Defects Congenital Pulmonary and Respiratory Medicine Infant General Medicine Fontan Procedure Treatment Outcome Child Preschool Hypoplastic Left Heart Syndrome Humans Surgery Child Cardiology and Cardiovascular Medicine Follow-Up Studies Retrospective Studies
Zdroj:	European Journal of Cardio-Thoracic Surgery. 62
ISSN:	1873-734X 1010-7940
DOI:	10.1093/ejcts/ezac301
Popis:	OBJECTIVES We sought to evaluate the long-term survival and risk factors for morbidity and mortality in our cohort of patients after extracardiac (EC) Fontan. METHODS We collected and analysed follow-up data until September 2020 for all patients who underwent EC Fontan operation at our institution from November 1988 to November 2015. RESULTS Out of 406 patients treated with EC Fontan at a mean age of 5.4 ± 4.5 years, 372 (91.6%) were discharged home; 15% were lost to follow-up. The median follow-up was 14.6 years (interquartile range 8.7–20.3). Two hundred patients (54%) had a good long-term outcome, with an event-free long-term survival, but late adverse events of any kind needing interventional or surgical reoperations were reported in 128 patients (34%). Forty-four patients (12%) developed late Fontan failure. Thirty-seven survivors (10%) had late arrhythmias, with the need for pacemaker implantation. Obstruction of the cavopulmonary pathway occurred in 49 patients (13%), but just 8 patients needed conduit surgical replacement. At 32 years, the survival probability was 84%. The risk of orthotopic heart transplant, considering death as a competing event (showed as cumulative incidence), was 12.5%. A preoperative diagnosis of hypoplastic left heart syndrome was an independent risk factor for the need for heart transplant. CONCLUSIONS The EC Fontan shows satisfactory long-term survival and low incidence of adverse events and late failure. Conduit replacement is rare, and its longevity may not represent a substantial issue in these patients. However, as with other technical variants, the need for reoperations during long-term follow-up is a significant challenge.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f698352ae5807305f9ecb0f762503c56 https://doi.org/10.1093/ejcts/ezac301 Zobrazit plný text záznamu