| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2006;131:172-180
© 2006 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
a Department of Surgery, Division of Cardiothoracic Surgery, University of Louisville, Louisville, Ky
b Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, Pa
c Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa
d Division of Pediatric Cardiology and Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa
e Division of Cardiothoracic Anesthesia, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa.
Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.
Received for publication April 12, 2004; revisions received June 8, 2005; accepted for publication August 1, 2005. * Address for reprints: Michael E. Mitchell, MD, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202. (Email: mmitchell{at}ucsamd.com).
OBJECTIVE: This study was undertaken to investigate the intermediate outcomes after the Fontan operation in the current era.
METHODS: A cross-sectional analysis was performed by using data gathered between October 13, 2003, and February 22, 2005, on all 310 survivors of the Fontan procedure between January 1, 1992, and December 31, 1999. Medical records were reviewed, and a customized questionnaire was administered to caregivers. Outcome variables included failure of the Fontan operation (ie, death, takedown of Fontan, or transplantation), number of cardiac-related rehospitalizations, parental assessment of health, school performance, and cardiac functional status.
RESULTS: A total of 332 patients underwent the Fontan procedure during the study period. A lateral tunnel was constructed in 281 (85%), and an extracardiac Fontan procedure was performed in 51 (15%). A total of 210 (63%) children had undergone previous stage I reconstruction, and 162 (49%) had received an initial diagnosis of hypoplastic left heart syndrome. There were 310 hospital survivors of the Fontan procedure (93.4%), with an additional 16 deaths (5.2%) during follow-up and 1 living heart transplant patient before the cross-sectional period. For initial hospital survivors, Kaplan-Meier estimates of freedom from death or transplantation were 98.0% (95% confidence interval, 95.6%-99.1%) at 1 year after the Fontan procedure, 94.9% (91.6%-97.0%) at 5 years, and 93.9% (90.1%-96.2%) at 8 years. Questionnaires were completed for 240 (81.9%) of the 293 available patients. By parental recollection, a total of 130 (54.2%) children required cardiac-related rehospitalization at some point during the follow-up period. At a median follow-up of 8.6 years (range, 4.1-12.8 years), 94.6% of guardians described their child's overall health as excellent or good, and 5.4%, as fair or poor. School performance was described as above average in 30.2%, average in 39.9%, and below average in 29.8%. With regard to cardiac functional status, 34.2% responded that their child had no limitations to physical activity, 52.5% reported a slight limitation, 12.1% reported a significant limitation, and 1.2% reported a severe limitation.
CONCLUSIONS: Acceptable survival outcomes have been observed at intermediate follow-up of the Fontan operation in this cohort; a significant proportion of patients had hypoplastic left heart syndrome. Although cardiac-related rehospitalization is common, the parents and guardians believed that overall health, school performance, and cardiac functional status were good to excellent for most patients.
This article has been cited by other articles:
|
|
 |
|
  M. A. Harris, M. T. Cosulich, M. J. Gillespie, K. K. Whitehead, T. I. Liu, P. M. Weinberg, and M. A. Fogel Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation J. Thorac. Cardiovasc. Surg., October 1, 2009; 138(4): 941 - 947. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Friedberg and L. Mertens Tissue velocities, strain, and strain rate for echocardiographic assessment of ventricular function in congenital heart disease Eur J Echocardiogr, July 1, 2009; 10(5): 585 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Szwast, Z. Tian, M. McCann, D. Donaghue, and J. Rychik Right Ventricular Performance in the Fetus With Hypoplastic Left Heart Syndrome Ann. Thorac. Surg., April 1, 2009; 87(4): 1214 - 1219. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Salvin, M. A. Scheurer, P. C. Laussen, J. E. Mayer Jr, P. J. del Nido, F. A. Pigula, E. A. Bacha, and R. R. Thiagarajan Factors Associated With Prolonged Recovery After the Fontan Operation Circulation, September 30, 2008; 118(14_suppl_1): S171 - S176. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Kon Healthcare Providers Must Offer Palliative Treatment to Parents of Neonates With Hypoplastic Left Heart Syndrome Arch Pediatr Adolesc Med, September 1, 2008; 162(9): 844 - 848. [Full Text] [PDF]
|
|
|
|
|
|
G. Wernovsky The Paradigm Shift Toward Surgical Intervention for Neonates With Hypoplastic Left Heart Syndrome Arch Pediatr Adolesc Med, September 1, 2008; 162(9): 849 - 854. [Full Text] [PDF]
|
|
|
|
|
|
S.-J. Kim, W.-H. Kim, H.-G. Lim, and J.-Y. Lee Outcome of 200 patients after an extracardiac Fontan procedure J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 108 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Kirshbom, W. T. Mahle, R. W. Joyner, T. Leong, M. Wilson, B. E. Kogon, K. R. Kanter, and M. M. Bouzyk The endothelin-1 G5665T polymorphism impacts transplant-free survival for single ventricle patients J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 117 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Khairy, S. M. Fernandes, J. E. Mayer Jr, J. K. Triedman, E. P. Walsh, J. E. Lock, and M. J. Landzberg Long-Term Survival, Modes of Death, and Predictors of Mortality in Patients With Fontan Surgery Circulation, January 1, 2008; 117(1): 85 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Creighton, C. M.T. Robertson, R. S. Sauve, D. M. Moddemann, G. Y. Alton, A. Nettel-Aguirre, D. B. Ross, I. M. Rebeyka, and and the Western Canadian Complex Pediatric Therapi Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger Pediatrics, September 1, 2007; 120(3): e478 - e486. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. N. Fenton, K. Lessman, K. Glogowski, S. Fogg, and K. F. Duncan Cerebral Oxygen Saturation Does Not Normalize Until After Stage 2 Single Ventricle Palliation Ann. Thorac. Surg., April 1, 2007; 83(4): 1431 - 1436. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Tanoue, H. Kado, N. Boku, H. Tatewaki, T. Nakano, K. Fukae, M. Masuda, and R. Tominaga Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 97 - 101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.-P. Diller, A. Uebing, K. Willson, L. C. Davies, K. Dimopoulos, S. A. Thorne, M. A. Gatzoulis, and D. P. Francis Analytical Identification of Ideal Pulmonary-Systemic Flow Balance in Patients With Bidirectional Cavopulmonary Shunt and Univentricular Circulation: Oxygen Delivery or Tissue Oxygenation? Circulation, September 19, 2006; 114(12): 1243 - 1250. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
