111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes

Constantine Mavroudis, Barbara J. Deal, Carl L. Backer, Robert D. Stewart, Wayne H. Franklin, Sabrina Tsao, Kendra M. Ward, R. Andrew DeFreitas

Research output: Contribution to journalArticle

Abstract

Background: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome. Methods: Since 1994, 111 patients (mean age 22.5 ± 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III). Results: There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 ± 12.1 days. Mean cross-clamp time was 70.8 ± 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3). Conclusions: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.

Original languageEnglish (US)
Pages (from-to)1457-1466
Number of pages10
JournalAnnals of Thoracic Surgery
Volume84
Issue number5
DOIs
StatePublished - Nov 1 2007
Externally publishedYes

Fingerprint

Cardiac Arrhythmias
Tachycardia
Atrial Fibrillation
Transplantation
Protein-Losing Enteropathies
Incidence
Heart Transplantation
Cardiopulmonary Bypass
Patient Selection
Renal Insufficiency
Dialysis
Length of Stay
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Mavroudis, C., Deal, B. J., Backer, C. L., Stewart, R. D., Franklin, W. H., Tsao, S., ... DeFreitas, R. A. (2007). 111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes. Annals of Thoracic Surgery, 84(5), 1457-1466. https://doi.org/10.1016/j.athoracsur.2007.06.079

111 Fontan Conversions with Arrhythmia Surgery : Surgical Lessons and Outcomes. / Mavroudis, Constantine; Deal, Barbara J.; Backer, Carl L.; Stewart, Robert D.; Franklin, Wayne H.; Tsao, Sabrina; Ward, Kendra M.; DeFreitas, R. Andrew.

In: Annals of Thoracic Surgery, Vol. 84, No. 5, 01.11.2007, p. 1457-1466.

Research output: Contribution to journalArticle

Mavroudis, C, Deal, BJ, Backer, CL, Stewart, RD, Franklin, WH, Tsao, S, Ward, KM & DeFreitas, RA 2007, '111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes', Annals of Thoracic Surgery, vol. 84, no. 5, pp. 1457-1466. https://doi.org/10.1016/j.athoracsur.2007.06.079
Mavroudis, Constantine ; Deal, Barbara J. ; Backer, Carl L. ; Stewart, Robert D. ; Franklin, Wayne H. ; Tsao, Sabrina ; Ward, Kendra M. ; DeFreitas, R. Andrew. / 111 Fontan Conversions with Arrhythmia Surgery : Surgical Lessons and Outcomes. In: Annals of Thoracic Surgery. 2007 ; Vol. 84, No. 5. pp. 1457-1466.
@article{af706672d37443de94e42974f8e9e219,
title = "111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes",
abstract = "Background: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome. Methods: Since 1994, 111 patients (mean age 22.5 ± 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III). Results: There were one early (0.9{\%}) and six late deaths (5.4{\%}); six patients required cardiac transplantation (5.4{\%}). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6{\%}). Mean hospital stay was 13.7 ± 12.1 days. Mean cross-clamp time was 70.8 ± 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5{\%}); 8 of 51 in group II (15.7{\%}) and 4 of 51 in group III (7.8) (p = 0.3). Conclusions: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.",
author = "Constantine Mavroudis and Deal, {Barbara J.} and Backer, {Carl L.} and Stewart, {Robert D.} and Franklin, {Wayne H.} and Sabrina Tsao and Ward, {Kendra M.} and DeFreitas, {R. Andrew}",
year = "2007",
month = "11",
day = "1",
doi = "10.1016/j.athoracsur.2007.06.079",
language = "English (US)",
volume = "84",
pages = "1457--1466",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - 111 Fontan Conversions with Arrhythmia Surgery

T2 - Surgical Lessons and Outcomes

AU - Mavroudis, Constantine

AU - Deal, Barbara J.

AU - Backer, Carl L.

AU - Stewart, Robert D.

AU - Franklin, Wayne H.

AU - Tsao, Sabrina

AU - Ward, Kendra M.

AU - DeFreitas, R. Andrew

PY - 2007/11/1

Y1 - 2007/11/1

N2 - Background: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome. Methods: Since 1994, 111 patients (mean age 22.5 ± 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III). Results: There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 ± 12.1 days. Mean cross-clamp time was 70.8 ± 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3). Conclusions: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.

AB - Background: The evolving operative strategy and course of 111 consecutive Fontan conversions with arrhythmia surgery and pacemaker therapy were reviewed to identify risk factors for poor outcome. Methods: Since 1994, 111 patients (mean age 22.5 ± 7.9 years) underwent Fontan conversion with arrhythmia surgery. The series was divided into three time periods: (1) 1994 to 1996 (initial isthmus ablation, n = 9, group I); (2) 1996 to 2003 (early modified right atrial maze and Cox-maze III, n = 51, group II); and (3) 2003 to 2006 (recent modifications of the modified right atrial maze and left atrial Cox-maze III for both atrial fibrillation and left atrial reentry tachycardia, n = 51, group III). Results: There were one early (0.9%) and six late deaths (5.4%); six patients required cardiac transplantation (5.4%). Two late deaths occurred after transplantation. Renal failure requiring dialysis occurred in four patients (3.6%). Mean hospital stay was 13.7 ± 12.1 days. Mean cross-clamp time was 70.8 ± 41.6 minutes. Four risk factors for death or transplantation were identified: presence of a right or ambiguous ventricle, preoperative protein-losing enteropathy, preoperative moderate-to-severe atrioventricular valve regurgitation, and long (>239 minutes) cardiopulmonary bypass time. In intergroup comparisons (groups I and II versus group III), three trends were noted: increased incidence of concomitant surgical repairs (p = 0.03), older patients (p = 0.01), and increased incidence of left atrial reentry tachycardia and atrial fibrillation (p = 0.04). Late recurrence of atrial tachycardia ensued in 15 of 111 (13.5%); 8 of 51 in group II (15.7%) and 4 of 51 in group III (7.8) (p = 0.3). Conclusions: Fontan conversion with arrhythmia surgery is safe and efficacious. Based on improved results and evolving surgical techniques, selection criteria can be more clearly defined.

UR - http://www.scopus.com/inward/record.url?scp=35348892562&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35348892562&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2007.06.079

DO - 10.1016/j.athoracsur.2007.06.079

M3 - Article

C2 - 17954046

AN - SCOPUS:35348892562

VL - 84

SP - 1457

EP - 1466

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -