Results of the Fontan operation with no early mortality in 248 consecutive patients

Background: The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects. Aim: The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. Methods: In the years 2007-2015, in 248 children aged 3.7 +/- 2.6 years and weighing 14.6 +/- 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a "beating heart" without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 +/- 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme. Results: All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 +/- 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 +/- 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke. Conclusions: Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation