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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 1049-1064, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JK Kirklin, EH Blackstone, JW Kirklin, AD Pacifico and LM Bargeron Jr
One hundred two patients, aged 0.7 to 38 years, with a wide variety of
cardiac malformations underwent the Fontan operation (1975 to April, 1985).
Several different techniques were used. All but 17 had previously undergone
one or more palliative operations. Follow-up information was obtained in
all patients. Overall actuarial survival rate, with time zero being the
time of the operation, was 63% at 6 years with no deaths after that in
patients followed as long as out to 9.4 years; that for patients with
tricuspid atresia was 81%. The hazard function (instantaneous risk) for
death was highest immediately after operation and merged after about 6
months with a constant hazard extending as long as the patients were
followed. Elevated post-repair right atrial pressure was correlated (p =
0.002) with the probability of death in the early phase, with the risk
rising rapidly with pressures above 14 mm Hg. Hypertrophy of the
ventricular main chamber was a risk factor for death in both the early (p =
0.007) and late (p = 0.008) phases of hazard, which explained in part the
lesser risk of the Fontan operation in patients with tricuspid atresia.
Younger age, but not older age, was a risk factor for early postoperative
death, but this risk was neutralized by recent date of operation. Thus
currently there is not a predicted increased risk associated with younger
age at operation. In general, the Fontan operation should be done at a
young age (2 to 4 years) to avoid increasing ventricular hypertrophy, but
older age per se is not a contraindication to the operation.
ARTICLES
The Fontan operation. Ventricular hypertrophy, age, and date of operation as risk factors
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H. Ichikawa, T. Yagihara, H. Kishimoto, F. Isobe, F. Yamamoto, K. Nishigaki, O. Matsuki, and T. Fujita Extent of Aortopulmonary Collateral Blood Flow as a Risk Factor for Fontan Operations Ann. Thorac. Surg., February 1, 1995; 59(2): 433 - 437. [Abstract] [Full Text]
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