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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 444-451, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JE Mayer Jr, ND Bridges, JE Lock, FL Hanley, RA Jonas and AR Castaneda
The Fontan operation was originally employed for patients with tricuspid
atresia, but its application has been extended to those with a variety of
complex defects in which there is functionally only a single ventricular
chamber. The outcome of 225 modified Fontan operations carried out between
1984 and 1990 at the Children's Hospital, Boston, for patients with defects
other than tricuspid atresia was reviewed. Overall 30 patients (13.3%) had
failure of this operation (death or takedown). Results improved
significantly during the period of the study, with failure rates of 6.5% (2
of 31) and 3.4% (2 of 59) in the last 2 years of the review. Multivariate
analysis showed that pulmonary artery distortion, pulmonary artery
pressure, age less than 3 years, use of a nonoxygenated glucose K+
cardioplegic solution, and cardiopulmonary bypass time greater than 180
minutes were associated with worse outcome, while "favorable"
atrioventricular valve anatomy (non-left atrioventricular valve
stenosis/atresia or common atrioventricular valve) and age greater than 9
years were associated with improved outcome. Excluding cardiopulmonary
bypass time from the multivariate analysis, the technique of atrial
partitioning for patients with left atrioventricular valve atresia/stenosis
became the most important variable, followed by the others noted in the
initial multivariate analysis except for age greater than 9 years. In the
last 2 years of the study 31.1% of patients were less than 3 years of age.
During the period of the study there was no significant decline in
preoperative risk factors. These results show that modified Fontan
operations can be carried out with a high likelihood of success in properly
selected patients with complex defects in whom there is functionally a
single ventricle.
ARTICLES
Factors associated with marked reduction in mortality for Fontan operations in patients with single ventricle
Department of Cardiovascular Surgery, Children's Hospital, Boston, MA 02115.
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A. K. Pridjian and J. L. Ochsner Aortopulmonary Fenestration With Pulmonary Artery Septation for Single Ventricle and Subaortic Obstruction Ann. Thorac. Surg., March 1, 1996; 61(3): 997 - 1000. [Abstract] [Full Text]
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H. Uemura, T. Yagihara, Y. Kawashima, F. Yamamoto, K. Nishigaki, O. Matsuki, K. Okada, T. Kamiya, and R. H. Anderson WHAT FACTORS AFFECT VENTRICULAR PERFORMANCE AFTER A FONTAN-TYPE OPERATION? J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 405 - 415. [Abstract] [Full Text]
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J. D. Waldman, R. B. Karp, J. J. Lamberti, M. E. Sand, D. G. Ruschhaupt, and B. Agarwala Tricuspid Valve Closure in Pulmonary Atresia and Important RV-to-Coronary Artery Connections Ann. Thorac. Surg., April 1, 1995; 59(4): 933 - 940. [Abstract] [Full Text]
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R. A. Jonas Indications and timing for the bidirectional Glenn shunt versus the fenestrated Fontan circulation J. Thorac. Cardiovasc. Surg., September 1, 1994; 108(3): 522 - 524. [Full Text]
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R. A. Jonas, D. D. Hansen, N. Cook, and D. Wessel Anatomic subtype and survival after reconstructive operation for hypoplastic left heart syndrome J. Thorac. Cardiovasc. Surg., April 1, 1994; 107(4): 1121 - 1128. [Abstract] [Full Text]
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