Although Fontan operation (FO) is a well-established method of hemodynamic correction of complex heart defects, the number of complications and mortality rate after this procedure remain relatively high. The aim of this investigation was to compare different strategies of FO in order to reveal the least risk approach to this procedure.
Retrospective analysis was performed on 247 FO during the years 1983-2001. The patients who underwent FO, were divided into 3 groups according to the type of correction: 1. Primary FO; 2. FO performed after previous systemic-pulmonary anastomosis (SPA); 3. FO performed after bidirectional cavopulmonary anastomosis (BCPA). In our analysis, we took into consideration the rate of early and late morbidity/mortality as well as the functional status of patients late after the procedure. The duration of follow-up in 145 patients, ranged from 6 months to 16 years, median – 4.5±3.4 years. Physical capacity and exercise hemodynamics were evaluated by bicycle ergometry.
Mortality and morbidity rate was the lowest after BCPA followed by FO (Table
Early and Late Results of Fontan operationMorbidity/ Mortality (%)Primary FOFO after SPAFO after BCPAEarly14.6%12.5%3.2%*Late15.5%26.5%8.0%*: * p<0.05 vs. other groups). Patients who underwent this type of correction also showed a higher physical capacity and more favorable exercise hemodynamics compared to other groups.CONCLUSIONS: The best results in hemodynamic correction of complex congenital heart defects (the lowest morbidity/mortality rate and more favorable hemodynamic outcome) were achieved when bidirectional cavopulmonary anastomosis preceded Fontan operation.
Bidirectional cavopulmonary anastomosis performed prior to Fontan operation reduces the risk of this procedure and improves its functional results.
S.B. Zaets, None.