Surgical Staging Strategy And Mid To Long Term Prognostic Analysis For Fontan Operation In Patients With Functional Univentricle

Objective:The aim of this study was to demonstrate short-term and long-term outcomes and their risk factors in patients who underwent a Fontan procedure,and to compare the outcomes of patients with different staging strategiesMethods:We reviewed all consecutive patients who underwent a Fontan procedure in our institution from January 1999 to January 2014.Perioperative results and follow-up data were obtained from medical records.Student's t-test,Wilcoxon rank sum test,Chi-square test,log-rank test,and Kaplan-Meier curves were used in statistic analysis performed by the SPSS 19.0 software package.All p values were two-sided,and p values of<0.05 were considered statistically significantResults:A total of 737 consecutive patients underwent a Fontan operation in Shanghai Children's Medical Center from January 1999 to January 2014,with overall early postoperative survival rate being 94.6%,overall cumulative 5 year and 10 year survival rate being 91.9%±1.1 and 89.3%±1.9%,and overall 5 year and 10 year cumulative freedom from failure of the Fontan procedure being 90.7%±1.2%and 84.9%±2.9%;189 patients underwent a single-stage Fontan operation,with early postoperative survival rate being 95.7%,cumulative 5 year survival rate being 93.3%±2.0%,and cumulative 5 year and 10 year survival rate being 92.2%±2.1%and 86.9%±4.0%;548 patients underwent a multi-stage Fontan operation,with early postoperative survival rate being 94.1%,cumulative 5 year survival rate being 91.7%±1.2%,and cumulative 5 year and 10 year survival rate being 90.3%±1.4%and 83.4%±4.5%.The overall follow-up rate was 91.8%among the surviving patients.Prognosis of adolescence to adult period needed further studyEarlier age at the time of the Fontan procedure and right ventricular-type morphology,longer CPB time,branch pulmonary arterioplasty were risk factors of early outcomes in single-stage and multi-stage Fontan operation,respectively;heterotaxy syndrome and high mPAP,moderate AV valve regurgitation and severe were risk factors of late outcomes in single-stage and multi-stage Fontan operation,respectively.A slow velocity of blood flow in IVC and an increased velocity of blood flow through the fenestration were predictors of worse long-term outcomesConclusions:Both single-stage and multi-stage Fontan procedures resulted in excellent early and late results.There was no statistic differences in prognosis between single-stage and multi-stage Fontan procedures.The staging strategy should be tailored to individual patients.In older patients who had already lost the optimal timing of bidirectional Glenn shunt,patients in reasonable compensated heart function and without severe cyanosis or exercise intolerance,a single-stage Fontan operation is a good option...