PMID- 28696879
OWN - NLM
STAT- MEDLINE
DCOM- 20170929
LR  - 20181202
IS  - 2150-136X (Electronic)
IS  - 2150-1351 (Linking)
VI  - 8
IP  - 4
DP  - 2017 Jul
TI  - Outcomes of Patients Undergoing Primary Fontan Operation Beyond First Decade of 
      Life.
PG  - 487-494
LID - 10.1177/2150135117713696 [doi]
AB  - OBJECTIVES: Studies on older patients undergoing primary Fontan operation (FO) 
      are limited, with conflicting results. We review our experience with these 
      patients beyond the first decade of life. PATIENTS AND METHODS: Between January 
      2000 and December 2014, a total of 105 patients >/=10 years of age (mean 15.6 +/- 
      4.9, range 10-31, median 15 years) underwent primary FO without a prior 
      bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). 
      Mean preoperative New York Heart Association (NYHA) class was 2.2 +/- 0.57. 
      RESULTS: Operative procedure was extra-cardiac FO in 62 patients (8 were 
      fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There 
      were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced 
      prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. 
      Two patients underwent Fontan takedown. On univariate analysis, NYHA functional 
      class III, mean pulmonary artery (PA) pressure >/=15 mm Hg, hematocrit >/=60%, 
      preoperative ventricular dysfunction, and atrioventricular valve regurgitation 
      (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 +/- 
      6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last 
      follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 
      84.7% +/- 3.7% at 5, 10, and 15 years. CONCLUSION: Carefully selected adolescents 
      and young adults can safely undergo the primary FO. However, persistent pleural 
      effusions, arrhythmias, thromboembolic events, and the need for reoperation 
      mandate regular follow-up in such patients. Preoperative NYHA functional class 
      III, mean PA pressure >== 15 mm Hg, hematocrit >/= 60%, ventricular dysfunction, and 
      AVVR were associated with early mortality, suggesting that primary FO should be 
      avoided in such patients.
FAU - Talwar, Sachin
AU  - Talwar S
AD  - 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of 
      Medical Sciences, New Delhi, India.
FAU - Singh, Sukhjeet
AU  - Singh S
AD  - 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of 
      Medical Sciences, New Delhi, India.
FAU - Sreenivas, Vishnubhatla
AU  - Sreenivas V
AD  - 2 Department of Biostatistics, All India Institute of Medical Sciences, New 
      Delhi, India.
FAU - Kapoor, Kulwant Singh
AU  - Kapoor KS
AD  - 2 Department of Biostatistics, All India Institute of Medical Sciences, New 
      Delhi, India.
FAU - Gupta, Saurabh Kumar
AU  - Gupta SK
AD  - 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India.
FAU - Ramakrishnan, Sivasubramanian
AU  - Ramakrishnan S
AD  - 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India.
FAU - Kothari, Shyam Sunder
AU  - Kothari SS
AD  - 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India.
FAU - Saxena, Anita
AU  - Saxena A
AD  - 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India.
FAU - Juneja, Rajnish
AU  - Juneja R
AD  - 3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 
      India.
FAU - Choudhary, Shiv Kumar
AU  - Choudhary SK
AD  - 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of 
      Medical Sciences, New Delhi, India.
FAU - Airan, Balram
AU  - Airan B
AD  - 1 Department of Cardiothoracic and Vascular Surgery, All India Institute of 
      Medical Sciences, New Delhi, India.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Pediatr Congenit Heart Surg
JT  - World journal for pediatric & congenital heart surgery
JID - 101518415
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Child
MH  - Female
MH  - Fontan Procedure/*methods
MH  - Heart Defects, Congenital/mortality/*surgery
MH  - Humans
MH  - Incidence
MH  - India/epidemiology
MH  - Male
MH  - Postoperative Complications/*epidemiology
MH  - Reoperation
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - CHD
OT  - adult congenital heart disease
OT  - congenital heart disease (CHD)
OT  - congenital heart surgery
OT  - univentricular heart
EDAT- 2017/07/12 06:00
MHDA- 2017/09/30 06:00
CRDT- 2017/07/12 06:00
PHST- 2017/07/12 06:00 [entrez]
PHST- 2017/07/12 06:00 [pubmed]
PHST- 2017/09/30 06:00 [medline]
AID - 10.1177/2150135117713696 [doi]
PST - ppublish
SO  - World J Pediatr Congenit Heart Surg. 2017 Jul;8(4):487-494. doi: 
      10.1177/2150135117713696.