Mortality and serious morbidity associated with Fontan revision surgery

  • Dr Zaheer Ahmad, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Gruschen Veldtman, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Hunaid Vohra, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Ransika Silva, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Saket Badle, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Robert Whistance, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Dr Anthony Salmon, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom
  • Mr Marcus Haw, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, United Kingdom

    • Objective:
    Fontan revision surgery though effective in relieving late arrhythmia burden associated with a failing Fontan circulation, has important mortality risk. Peri-operative serious morbidity, however, is poorly described. We sought to define mortality [< 30 days, in hospital and late mortality] and serious morbidity [renal replacement therapy (RRT), prolonged ICU stay > 10 days] and a composite endpoint (CE) of death, ECMO, RRT, prolonged ICU stays and ventilation > 3days, in this group.
    Methods:
    Hospital records were retrospectively reviewed for baseline and peri-operative characteristics, as well as outcomes as defined by the endpoints above.
    Results:
    40 patients (19 female, mean age 24±9 years, range: 9-48years) had Fontan revision surgery during 1997 through 2008, for arrhythmia in 29 patients, pathway obstruction in 2 patients, arrhythmia and pathway obstruction in 5 patients and effort intolerance in 3. Mean bypass time was 237±93mins. The 30-day mortality was 7% (n=3) and in-hospital mortality 12% (n=5). Five-year actuarial survival was 76±7% and 65±11% at 10 years. Serious morbidity included: RRT (n=7,17.5%; 5 died), prolonged ICU stay (n=8,20%; 4 died), ECMO (n=1) and CE (n=13,32%, 5 died). Ventricular dysfunction was an independent predictor of RRT and prolonged ICU stay (p<0.01), and the composite end point. The use of circulatory arrest was associated with prolonged ICU stay and prolonged ventilation (p<0.05)
    Conclusions:
    Fontan revision surgery though having a relatively low 30-day mortality, is commonly associated with serious morbidity. Specialized and dedicated peri-operative care is paramount in achieving good outcomes. Risk stratification remains challenging in this group.