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The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 711-719, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
F Fontan, G Fernandez, F Costa, DC Naftel, F Tritto, EH Blackstone and JW Kirklin
All patients (n = 334) undergoing the Fontan operation at the University of
Bordeaux, France, and the University of Alabama Medical Center, Birmingham,
were entered into a single data base to examine the relation, if any,
between size of the pulmonary arteries and outcome. Recent follow-up was
made of all patients. The time-related freedom from death or takedown of
the Fontan operation was 78% at 1 month, 73% at 6 months, and 72%, 68%,
61%, and 50% at 1, 5, 10, and 15 years after the operation. The hazard
function (instantaneous risk of the combined event at each moment in time
after the operation) had a rapidly declining early phase that gave way at
about 6 months to a late phase of hazard, which began slowly to rise about
8 years after the operation. One of the most powerful risk factors for
death or takedown of the Fontan operation was the dimensions of the right
and left pulmonary arteries, expressed as a McGoon ratio. By multivariate
analysis, the risk of the combined event increased sharply when the McGoon
ratio was less than about 1.8, and when the ratio was as low as 1.2 the
probability of death or takedown within 30 days of the operation was
predicted to be 55% when the right atrium was connected to the pulmonary
artery and 34% when connected to the right ventricle. Other risk factors
identified were age at operation, the presence of mitral atresia, the
degree of main chamber hypertrophy, elevated pulmonary artery pressure,
non-use of cardioplegia, global myocardial ischemic time, and attachment of
the right atrium to the pulmonary artery rather than to the right
ventricle.
ARTICLES
The size of the pulmonary arteries and the results of the Fontan operation
Surgical Clinic for Cardiac Diseases, Hopital Cardiologique du Haut- Leveque, Bordeaux, France.
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