Objective: To evaluate the early and long-term outcome of those patients that have completed their staging protocol by means of a Fontan procedure at the altitude of Mexico city (2420m over the sea level) in a 17 year period.
Methods: We studied retrospectively 98 patients (51% female) with mean age of 8 years (range, 1 to 22.7 years) that had univentricular heart physiology and underwent a Fontan procedure, 61 with an intracardiac lateral tunnel technique (41 fenestraded, 20 non fenestrated) and 37 with an extracardiac conduit (29 fenestrated, 8 non fenestrated). Review of their clinical, surgical, echocardiographic, angiographic and hemodynamic data was performed to identify risk factors for mortality. Follow up was complete in all survivors.
Results: The most common causes of early morbidity were pleural effusions (98%) and ascitis (24%). Early mortality was as high as 17% with intracardiac lateral tunnel technique but dropped to 5% with extracardiac fenestrated technique since 1998-1999. Pulmonary artery pressure (p<0.01), left atrial pressure (p<0.01) and quantity of effusions (p<0.05) were risk factors for early death. Mean follow up was 8.6 years. Overall survival at ten years was 73%. Late reinterventions were necessary in 22 (30%) of the survivors and 9 of them (12.6%) had neurological disorders.
Conclusions: Our best results were with extracardiac fenestrated technique, comparable with those of larger series, but our morbidity (effusions and ascitis mostly) is higher, maybe due to Mexico city altitude. Better selection of patients help to reach a long-term survival with improvement in the quality of life.