Predicting outcome after Fontan palliation: a single-centre experience, using simple clinical variables.

ABSTRACT

BACKGROUND: The Fontan procedure has become the procedure of choice for patients with one functional ventricle. Although perioperative mortality has decreased, late failure of the Fontan circulation remains a major concern. We aimed at (i) describing Fontan patient characteristics and (ii) identifying simple risk factors for outcome. METHODS: Seventy-three patients (median age 23 y (IQR 19-29 y), 60.3% male) were selected from the database of congenital heart defects. Followup data were collected. The primary end point was composed by death, resuscitation, or heart transplantation. RESULTS: The most frequently occurring defect was tricuspid atresia (41.1%). Twenty-five (34.2%) and 48 (65.8%) patients received an intra- and extracardiac conduit, respectively. Ten patients reached the primary end point (13.7%) after a median follow-up time of 16 years (IQR 14-19 y). NYHA classification (OR 63.0; 95% Cl 6.7-592.4; P < or =0.001), atrioventricular-valve regurgitation (OR 10.6; 95% Cl 1.2-94.1; P = 0.034), ventricular function (OR 4.8; 95% Cl 1.7-13.7; P = 0.003), oxygen saturation (OR 0.7; 95% Cl 0.1-1.0; P = 0.002) and the presence (OR 8.6; 95% Cl 1.6-45.2; P = 0.011) or history of supraventricular arrhythmia (OR 6.7; 95% CI 1.3-35.0; P = 0.025), all parameters gathered at the latest follow-up, were associated with outcome. An association was also found with the presence of an intracardiac conduit (OR 5.8; 95% Cl 1.4-25.1; P = 0.018), higher age at Fontan procedure (OR 1.2; 95% Cl 1.0-1.3; P = 0.007) and male gender (OR 0.2; 95% Cl 0.1-1.0; P = 0.047). CONCLUSIONS: Complications were not uncommon later after Fontan surgery. Several demographic and procedure-related data were associated with adverse outcome. Interestingly, the strongest correlation was found with clinical and basic echocardiographic characteristics at the latest follow-up.