TY - JOUR
T1 - Contemporary fontan operation
T2 - Association between early outcome and type of cavopulmonary connection
AU - Stewart, Robert D.
AU - Pasquali, Sara K.
AU - Jacobs, Jeffrey P.
AU - Benjamin, Daniel K.
AU - Jaggers, James
AU - Cheng, Julie
AU - Mavroudis, Constantine
AU - Jacobs, Marshall L.
N1 - Funding Information:
Dr Pasquali received grant support from the National Heart, Lung, and Blood Institute ( 1K08HL103631-01 ).
PY - 2012/4
Y1 - 2012/4
N2 - Background: Extracardiac conduit and lateral atrial tunnel total cavopulmonary connection are both widely used in the management of functionally univentricular hearts. The effect of the type of connection on early outcomes after Fontan operation remains unclear. We evaluated the effect of Fontan type on early outcome in a large clinical database. Methods: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000 to 2009) were included. We used multivariable analysis to evaluate the effect of Fontan type (extracardiac conduit vs lateral tunnel) on in-hospital death, Fontan takedown/revision, Fontan failure (in-hospital death or Fontan takedown/revision), postoperative length of stay, and complications, adjusting for patient, procedural, and center factors. Results: The study included 2,747 patients (61% male) from 68 centers. A right-dominant ventricle was present in 45%. Extracardiac conduit Fontan (vs lateral atrial tunnel) was performed in 63%; in all, 65% were fenestrated. In multivariable analysis with adjustment for patient, procedural (including fenestration), and center factors (including Fontan volume), the extracardiac conduit Fontan was associated with significantly higher Fontan takedown/revision (odds ratio, 2.73; 95% confidence interval, 1.09 to 6.87) and Fontan failure (odds ratio, 2.28; 95% confidence interval, 1.13 to 4.59), and longer postoperative hospital stay (adjusted estimated difference in postoperative hospital stay: +1.4 days). Conclusions: These multicenter data suggest that of the two prevalent forms of Fontan connection in current use, the lateral atrial tunnel Fontan may be associated with superior early outcomes.
AB - Background: Extracardiac conduit and lateral atrial tunnel total cavopulmonary connection are both widely used in the management of functionally univentricular hearts. The effect of the type of connection on early outcomes after Fontan operation remains unclear. We evaluated the effect of Fontan type on early outcome in a large clinical database. Methods: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000 to 2009) were included. We used multivariable analysis to evaluate the effect of Fontan type (extracardiac conduit vs lateral tunnel) on in-hospital death, Fontan takedown/revision, Fontan failure (in-hospital death or Fontan takedown/revision), postoperative length of stay, and complications, adjusting for patient, procedural, and center factors. Results: The study included 2,747 patients (61% male) from 68 centers. A right-dominant ventricle was present in 45%. Extracardiac conduit Fontan (vs lateral atrial tunnel) was performed in 63%; in all, 65% were fenestrated. In multivariable analysis with adjustment for patient, procedural (including fenestration), and center factors (including Fontan volume), the extracardiac conduit Fontan was associated with significantly higher Fontan takedown/revision (odds ratio, 2.73; 95% confidence interval, 1.09 to 6.87) and Fontan failure (odds ratio, 2.28; 95% confidence interval, 1.13 to 4.59), and longer postoperative hospital stay (adjusted estimated difference in postoperative hospital stay: +1.4 days). Conclusions: These multicenter data suggest that of the two prevalent forms of Fontan connection in current use, the lateral atrial tunnel Fontan may be associated with superior early outcomes.
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U2 - 10.1016/j.athoracsur.2012.01.060
DO - 10.1016/j.athoracsur.2012.01.060
M3 - Article
C2 - 22450074
AN - SCOPUS:84859014185
VL - 93
SP - 1254
EP - 1261
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -