The Fontan Procedure Contemporary Techniques Have Improved Long-Term Outcomes

Background—To determine whether patients undergoing the lateral tunnel and extracardiac conduit modifications of the Fontan procedure have better outcomes than patients undergoing a classical atriopulmonary connection. Methods and Results—Between 1980 and 2000, 305 consecutive patients underwent a Fontan procedure at our institution. There were 10 hospital deaths (mortality: 3%) with no death after 1990. Independent risk factors for mortality were preoperative elevated pulmonary artery pressures (P0.002) and common atrioventricular valve (P0.04). Fontan was taken down during hospital stay in 7 patients. A mean of 126 years of follow-up was obtained in the 257 nonforeign Fontan survivors. Completeness of concurrent follow-up was 96%. Twenty-year survival was 84 % (95 % CI: 79 to 89%). Recent techniques improved late survival. The 15-year survival after atriopulmonary connection was 81 % (95 % CI: 73% to 87%) versus 94 % (95 % CI: 79 % to 98%) for lateral tunnel (P0.004). Nine pts required heart transplantation (8 atriopulmonary connection, 1 lateral tunnel). Undergoing a Fontan modification independently predicted decreased occurrence of arrhythmia, and 15-year freedom from SVT was 61 % (95 % CI: 51 % to 70%) for atriopulmonary connection versus 87 % (95 % CI: 76 % to 93%) for lateral tunnel (P0.02). Freedom from Fontan failure (death, take-down, transplantation, or NYHA class III-IV) was 70 % (95 % CI: 58 % to 79%) at 20 years. After extra-cardiac conduits, no death, SVT, or failure was observed. Conclusions—The Fontan procedure remains a palliation, but outcomes of patients have improved. Better patient selectio