PMID- 12614799
OWN - NLM
STAT- MEDLINE
DCOM- 20030703
LR  - 20190513
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 23
IP  - 3
DP  - 2003 Mar
TI  - Early and medium-term results after modified Fontan operation in adults.
PG  - 311-6
AB  - OBJECTIVE: Single ventricle palliation is rarely performed in adults and the 
      results are less optimal than in children. In this article we analyze our 
      experience with the modified Fontan operation in this age group. METHODS: Data of 
      15 consecutive patients with single ventricle with a mean age of 26 (range 16-38) 
      years, who underwent Fontan operation between 3/92 and 1/2000 were 
      retrospectively analyzed. Five patients had previously had an aortopulmonary 
      shunt in childhood and two patients had previously received a bi-directional 
      cavopulmonary shunt as adults. Eleven patients were preoperatively in NYHA class 
      III and four in class II. The main factors for the selection of the patients 
      before surgery were well-developed pulmonary arteries with lower lobe index 
      120+30 mm/m(2), pulmonary artery pressure <18 mmHg, good cardiac function and 
      enddiastolic systemic ventricular pressure <12 mmHg. The lateral tunnel Fontan 
      operation (LTFO) was performed in ten patients and extracardiac Fontan operation 
      (ECFO) in five. A fenestration 4-5 mm in size was constructed in all patients 
      with LTFO and in three of five patients with ECFO. RESULTS: There was one 
      intraoperative and one late death (total mortality 13%). The mean extubation time 
      and hospital stay were 24 h and 21 days, respectively. Severe postoperative 
      complications were observed in three patients (20%). Two LTFO patients out of a 
      total of eight patients (53%) with perioperative arrhythmias received a permanent 
      pacemaker due to bradyarrhythmia. During the median follow-up of 5.0 (range 
      2.3-10.1) years, four patients developed arrhythmias; one of them had new onset 
      bradyarrhythmia after LTFO and required permanent pacemaker implantation. The 
      median postoperative oxygen saturation was 93% (range 90-98%). NYHA class 
      improved significantly in 12 survivors. Cardiac catheterization (0.5-4 years 
      postoperatively, n=12) showed excellent Fontan hemodynamics in all patients. 
      CONCLUSIONS: The modified Fontan operation can be performed in adults with 
      acceptable early and midterm mortality and morbidity and leads to either complete 
      or marked relief of cyanosis and enhanced exercise tolerance in all survivors. 
      Postoperative arrhythmias are one of the main drawbacks but the incidence of 
      arrhythmias after ECFO seems to be lower. The long-term follow-up has yet to be 
      established.
FAU - Ovroutski, S
AU  - Ovroutski S
AD  - Department of Congenital Heart Diseases, German Heart Institute Berlin, Berlin, 
      Germany. ovroutski@dhzb.de
FAU - Alexi-Meskishvili, V
AU  - Alexi-Meskishvili V
FAU - Ewert, P
AU  - Ewert P
FAU - Nurnberg, J-H
AU  - Nurnberg JH
FAU - Hetzer, R
AU  - Hetzer R
FAU - Lange, P E
AU  - Lange PE
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Arrhythmias, Cardiac/etiology
MH  - Follow-Up Studies
MH  - Fontan Procedure/*methods
MH  - Heart Defects, Congenital/*surgery
MH  - Humans
MH  - Length of Stay
MH  - Patient Selection
MH  - Postoperative Complications
MH  - Reoperation
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2003/03/05 04:00
MHDA- 2003/07/04 05:00
CRDT- 2003/03/05 04:00
PHST- 2003/03/05 04:00 [pubmed]
PHST- 2003/07/04 05:00 [medline]
PHST- 2003/03/05 04:00 [entrez]
AID - S1010794002008291 [pii]
AID - 10.1016/s1010-7940(02)00829-1 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2003 Mar;23(3):311-6. doi: 
      10.1016/s1010-7940(02)00829-1.