Clinical course after Fontan palliation: Single center experience

Abstract

Background

The Fontan procedure has been the standard palliation for single-ventricle patients. We aimed to investigate the short- and midterm outcomes of patients who underwent Fontan palliation.

Objectives

To assess and analyze the clinical course, including length of stay, complications, and mortality of single ventricle patients undergoing Fontan Palliation.

Methods

Retrospective review of all patients who underwent Fontan palliation at the University of Minnesota, 2006–2020. The primary outcomes measured were length of stay, complications, and Fontan failure.

Results

Of the 55 patients the median age of Fontan was 3.9 yrs [2.63, 4.19] and the most common diagnoses were hypoplastic left heart syndrome (n = 20, 36 %), double inlet left ventricle (n = 11, 20 %) and double outlet right ventricle (n = 8, 15 %). Twenty-Seven were right ventricle dominant, 23 were left ventricle dominant, and 5 had biventricular morphology. The median hospital stay was 11 days [8, 17.5], an ICU stay of 6.5 days [4,9]. Fourteen late complications occurred in 10 patients. Three, all with HLHS, had Fontan failure leading to heart transplant. Four died: two prior to hospital discharge, one 6.7 yrs post-Fontan, and one 27 days after transplantation. Right ventricle morphology was associated with prolonged ICU (P 0.05), prolonged hospital stay (P < 0.01), and complications resulting in Fontan failure (P < 0.01).

Conclusion

The survival following Fontan completion in the current era is excellent, with an overall and transplant-free survival at 5 and 10 years were at 96 % and 93 %. However, it is clear that univentricular physiology continues to present challenges, and patients remain at risk for morbidity, especially for patients with right ventricle morphology.