40-Year Follow-Up after the Fontan Operation Long-Term Outcomes of 1,052 Patients

Kavitha N. Pundi, Jonathan N. Johnson, Joseph A. Dearani, Krishna N. Pundi, Zhuo Li, Cynthia A. Hinck, Sonja H. Dahl, Bryan C. Cannon, Patrick W. O'Leary, David J. Driscoll, Frank Cetta

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Background There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation. Objectives This study sought to determine the long-term outcome of all patients who had a Fontan operation at the Mayo Clinic. Methods Records of all patients who had a modified Fontan operation between 1973 and 2012 were reviewed. A follow-up questionnaire was mailed to all patients alive at the time of the study. Results Overall, 10-, 20-, and 30-year survival for 1,052 patients was 74%, 61%, and 43%, respectively. Factors associated with decreased overall or late survival in multivariate analysis included pre-operative diuretic use, longer cardiopulmonary bypass time, operation prior to 1991, atrioventricular valve (AVV) replacement at the time of Fontan operation, elevated post-bypass Fontan (>20 mm Hg) or left atrial (>13 mm Hg) pressures, prolonged chest tube drainage (>21 days), post-operative ventricular arrhythmias, renal insufficiency, and development of protein-losing enteropathy (PLE). Pre-operative and intraoperative sinus rhythm were associated with improved survival. Long-term survival was similar for patients regardless of ventricular morphology. The most common reoperations were pacemaker insertion/revision in 212 patients (20%), Fontan revision/conversion in 117 patients (11%), and AVV repair/replacement in 66 patients (5%). Clinically significant late atrial or ventricular arrhythmias occurred in 468 patients (44%). Ninety-five patients (9%) developed PLE, and 5-, 10-, and 20-year survival after diagnosis of PLE was 50%, 35%, and 19%, respectively. Conclusions As the surgical techniques for the Fontan operation have changed over the last 40 years, survival has improved. However, development of PLE and arrhythmias and the need for reoperation during long-term follow-up pose significant management challenges.

Original languageEnglish (US)
Pages (from-to)1700-1710
Number of pages11
JournalJournal of the American College of Cardiology
Volume66
Issue number15
DOIs
StatePublished - Oct 13 2015

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Fontan Procedure
Protein-Losing Enteropathies
Survival
Cardiac Arrhythmias
Reoperation
Chest Tubes
Time and Motion Studies
Cardiopulmonary Bypass
Diuretics
Renal Insufficiency
Drainage
Multivariate Analysis

Keywords

  • Fontan procedure
  • protein-losing enteropathy
  • survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pundi, K. N., Johnson, J. N., Dearani, J. A., Pundi, K. N., Li, Z., Hinck, C. A., ... Cetta, F. (2015). 40-Year Follow-Up after the Fontan Operation Long-Term Outcomes of 1,052 Patients. Journal of the American College of Cardiology, 66(15), 1700-1710. https://doi.org/10.1016/j.jacc.2015.07.065

40-Year Follow-Up after the Fontan Operation Long-Term Outcomes of 1,052 Patients. / Pundi, Kavitha N.; Johnson, Jonathan N.; Dearani, Joseph A.; Pundi, Krishna N.; Li, Zhuo; Hinck, Cynthia A.; Dahl, Sonja H.; Cannon, Bryan C.; O'Leary, Patrick W.; Driscoll, David J.; Cetta, Frank.

In: Journal of the American College of Cardiology, Vol. 66, No. 15, 13.10.2015, p. 1700-1710.

Research output: Contribution to journalArticle

Pundi, KN, Johnson, JN, Dearani, JA, Pundi, KN, Li, Z, Hinck, CA, Dahl, SH, Cannon, BC, O'Leary, PW, Driscoll, DJ & Cetta, F 2015, '40-Year Follow-Up after the Fontan Operation Long-Term Outcomes of 1,052 Patients', Journal of the American College of Cardiology, vol. 66, no. 15, pp. 1700-1710. https://doi.org/10.1016/j.jacc.2015.07.065
Pundi, Kavitha N. ; Johnson, Jonathan N. ; Dearani, Joseph A. ; Pundi, Krishna N. ; Li, Zhuo ; Hinck, Cynthia A. ; Dahl, Sonja H. ; Cannon, Bryan C. ; O'Leary, Patrick W. ; Driscoll, David J. ; Cetta, Frank. / 40-Year Follow-Up after the Fontan Operation Long-Term Outcomes of 1,052 Patients. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 15. pp. 1700-1710.
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abstract = "Background There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation. Objectives This study sought to determine the long-term outcome of all patients who had a Fontan operation at the Mayo Clinic. Methods Records of all patients who had a modified Fontan operation between 1973 and 2012 were reviewed. A follow-up questionnaire was mailed to all patients alive at the time of the study. Results Overall, 10-, 20-, and 30-year survival for 1,052 patients was 74{\%}, 61{\%}, and 43{\%}, respectively. Factors associated with decreased overall or late survival in multivariate analysis included pre-operative diuretic use, longer cardiopulmonary bypass time, operation prior to 1991, atrioventricular valve (AVV) replacement at the time of Fontan operation, elevated post-bypass Fontan (>20 mm Hg) or left atrial (>13 mm Hg) pressures, prolonged chest tube drainage (>21 days), post-operative ventricular arrhythmias, renal insufficiency, and development of protein-losing enteropathy (PLE). Pre-operative and intraoperative sinus rhythm were associated with improved survival. Long-term survival was similar for patients regardless of ventricular morphology. The most common reoperations were pacemaker insertion/revision in 212 patients (20{\%}), Fontan revision/conversion in 117 patients (11{\%}), and AVV repair/replacement in 66 patients (5{\%}). Clinically significant late atrial or ventricular arrhythmias occurred in 468 patients (44{\%}). Ninety-five patients (9{\%}) developed PLE, and 5-, 10-, and 20-year survival after diagnosis of PLE was 50{\%}, 35{\%}, and 19{\%}, respectively. Conclusions As the surgical techniques for the Fontan operation have changed over the last 40 years, survival has improved. However, development of PLE and arrhythmias and the need for reoperation during long-term follow-up pose significant management challenges.",
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AU - Johnson, Jonathan N.

AU - Dearani, Joseph A.

AU - Pundi, Krishna N.

AU - Li, Zhuo

AU - Hinck, Cynthia A.

AU - Dahl, Sonja H.

AU - Cannon, Bryan C.

AU - O'Leary, Patrick W.

AU - Driscoll, David J.

AU - Cetta, Frank

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AB - Background There are limited long-term, single-cohort, follow-up studies available about patients after the Fontan operation. Objectives This study sought to determine the long-term outcome of all patients who had a Fontan operation at the Mayo Clinic. Methods Records of all patients who had a modified Fontan operation between 1973 and 2012 were reviewed. A follow-up questionnaire was mailed to all patients alive at the time of the study. Results Overall, 10-, 20-, and 30-year survival for 1,052 patients was 74%, 61%, and 43%, respectively. Factors associated with decreased overall or late survival in multivariate analysis included pre-operative diuretic use, longer cardiopulmonary bypass time, operation prior to 1991, atrioventricular valve (AVV) replacement at the time of Fontan operation, elevated post-bypass Fontan (>20 mm Hg) or left atrial (>13 mm Hg) pressures, prolonged chest tube drainage (>21 days), post-operative ventricular arrhythmias, renal insufficiency, and development of protein-losing enteropathy (PLE). Pre-operative and intraoperative sinus rhythm were associated with improved survival. Long-term survival was similar for patients regardless of ventricular morphology. The most common reoperations were pacemaker insertion/revision in 212 patients (20%), Fontan revision/conversion in 117 patients (11%), and AVV repair/replacement in 66 patients (5%). Clinically significant late atrial or ventricular arrhythmias occurred in 468 patients (44%). Ninety-five patients (9%) developed PLE, and 5-, 10-, and 20-year survival after diagnosis of PLE was 50%, 35%, and 19%, respectively. Conclusions As the surgical techniques for the Fontan operation have changed over the last 40 years, survival has improved. However, development of PLE and arrhythmias and the need for reoperation during long-term follow-up pose significant management challenges.

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