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Title: Can Fontan Conversion For Patients Without Late Fontan Complications Be Justified?
Authors: Higashida, Akihiko;Hoashi, Takaya;Kagisaki, Koji;Shimada, Masatoshi;Ohuchi, Hideo;Shiraishi, Isao;Ichikawa, Hajime
subject: Medical Science
Year: 2017
Publisher: The Society of Thoracic Surgeons and The American Association for Thoracic Surgery
Abstract: Background: Fontan conversion from a classic Fontan operation such as atriopulmonary connection to total cavopulmonary connection with antiarrhythmia surgery is currently not indicated for patients without any late Fontan complications. Methods: Thirty-two consecutive patients who underwent Fontan conversion between 1991 and 2012 were divided into 2 groups by the presence (group 1: n = 25, atrial tachyarrhythmia [AT] in 24 and protein-losing enteropathy in 4) or absence (group 2: n = 7) of late Fontan complications, and the surgical outcomes were retrospectively compared. During the study period, heart transplantation was not indicated for patients with failed Fontan circulation in Japan. Results: The mean follow-up period was 6.2 ?? 3.7 years in group 1 and 4.6 ?? 3.8 years in group 2 (p = 0.29). Overall survival rate at 10 years after conversion was 71% in group 1 and 100% in group 2 (p = 0.12). Whereas preoperative AT and protein-losing enteropathy remained after conversion in 8 patients (33%) and all 4 patients (100%), respectively, in group 1, neither were observed in group 2. Cardiac catheter examinations presurgery (n = 32) at 1 year (n = 28), and at 5 years (n = 19) after the conversion showed that the cardiac index significantly and similarly improved in both groups after the conversion, and maintained for at least 5 years. Conclusions: Cardiac output similarly improved after Fontan conversion in patients with or without late Fontan complications by elimination of venous blood congestion on Fontan pathways. Although long-term follow-up is mandatory, newly onset AT was not observed after prophylactic Fontan conversion.
volume: Volume 103
issue: Issue 5
month: May
Appears in Collections:Annals of thoracic surgery 2017

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