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Outcome after the single-stage, nonfenestrated Fontan procedure.

Abstract：

BACKGROUND:A completed Fontan circulation is the goal in the management of patients with single-ventricle physiology. To achieve this end, a two-stage rather than a single-stage approach is carried out routinely at many centers. Some groups have advocated baffle fenestration for virtually all patients to minimize post-Fontan complications. Other centers perform single-stage Fontan operations and do not fenestrate. Thus controversies have arisen regarding the indications for the staged procedure versus single stage and for fenestration versus no fenestration. METHODS AND RESULTS:The preoperative risk factors and postoperative course were characterized in 61 consecutive patients (median age, 3.3 years) undergoing a single-stage, nonfenestrated Fontan. The patients were followed for 3.5+/-1.9 years. The relationship between preoperative risk factors and mortality and morbidity was assessed. Preoperative risk factors assessed included age <2 years (n=18), branch pulmonary artery stenosis (n=20), elevated mean pulmonary artery pressure >15 mm Hg (n=16), atrioventricular valve regurgitation (n=5), and decreased ventricular function (n=2). Total caval pulmonary anastomosis was performed in 53 patients. Additional surgery was required at the time of the Fontan in 25 patients (41%). The median duration of mechanical ventilation was 1 day; median chest tube drainage was 5.5 days (range, 1 to 35). Oxygen saturation rose significantly postoperatively, from 83% to 95%. Early mortality was 4.9%; one patient died from pacemaker failure 9 months postoperatively, and one patient underwent successful heart transplant 4 months post-Fontan. One- and 5-year actuarial survival was 93%. No preoperative risk factor was associated with a failed Fontan or significant effusions. CONCLUSIONS:A single-stage, nonfenestrated Fontan was performed in a large group of patients with excellent surgical results and intermediate outcome. There is no evidence that a two-stage approach and/or baffle fenestration is required for a large cohort of patients who are candidates for a Fontan operation.

journal_name

Circulation

journal_title

Circulation

authors

Hsu DT,Quaegebeur JM,Ing FF,Selber EJ,Lamour JM,Gersony WM

subject

Has Abstract

pub_date

1997-11-04 00:00:00

pages

II-335-40

issue

9 Suppl

eissn

0009-7322

issn

1524-4539

journal_volume

pub_type

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Outcome after the single-stage, nonfenestrated Fontan procedure.