Fontan with lateral tunnel is associated with improved survival compared with extracardiac conduit

ObjectivesThe mechanisms of attrition of the Fontan population have been poorly characterised and it is unclear whether some of the deaths are potentially preventable. We analysed the circumstances of late death in patients with a Fontan circulation, with a special focus on identifying lesions amenable to intervention that may have contributed to the decline of their circulation.MethodsBetween 1975 and 2018, a total of 105 patients from a Bi-National Registry died beyond 1 year after Fontan completion, at a median age of 18.6 (IQR 13.8–26.0) years old, 12.7 (IQR 6.0–19.3) years after Fontan completion.ResultsA total of 105 patients died—63 patients (60%) with an atriopulmonary (AP) Fontan, 21 patients (20%) with a lateral tunnel (LT) and 21 patients (20%) with an extracardiac conduit (ECC). 72 patients (69%) were reviewed within 2 years preceding death, with 32% (23/72) deemed to be clinically well. Fontan circulatory failure was the most common cause of death in 42 patients (45%). Other causes of death included sudden death/arrhythmia (19%), perioperative death (12%), neurological complication (7%) and thromboembolism (7%). All patients with an LT or ECC who died from Fontan failure had at least one surgical defect that was amenable to intervention at time of death.ConclusionsConventional clinical surveillance has been insensitive in detecting a significant proportion of patients at risk of late death. Fontan circulatory failure contributes to half of the late deaths. Patients with an LT or ECC Fontan who died with a clinical picture of circulation failure may have potentially correctable lesions.

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Extracardiac conduit Fontan procedure versus intra-atrial lateral tunnel Fontan procedure

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-012-0161-9 ◽

2012 ◽

Vol 60 (12) ◽

pp. 792-795 ◽

Cited By ~ 5

Author(s):

Toshiyuki Katogi

Keyword(s):

Fontan Procedure ◽

Extracardiac Conduit ◽

Lateral Tunnel

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Conversion of the failed Fontan circulation

Cardiology in the Young ◽

10.1017/s1047951105002386 ◽

2006 ◽

Vol 16 (S1) ◽

pp. 85-91 ◽

Cited By ~ 38

Author(s):

Carl L. Backer ◽

Barbara J. Deal ◽

Constantine Mavroudis ◽

Wayne H. Franklin ◽

Robert D. Stewart

Keyword(s):

New York ◽

Heart Association ◽

Fontan Circulation ◽

Right Atrial ◽

Univentricular Heart ◽

Extracardiac Conduit ◽

Lateral Tunnel ◽

New York Heart Association

Many patients with a functional univentricular heart were treated in the 1970s and 1980s, using an atriopulmonary connection to create the Fontan circulation.1–3Although this procedure, in many patients, was initially successful, and provided arterial saturations of oxygen close to normal, as these patients were followed over the years, in some cases they developed significant complications. One complication of the atriopulmonary connection is progressive right atrial dilation, which leads to atrial arrhythmias, such as atrial flutter or fibrillation.4,5The combination of these two problems leads to low cardiac output, diminished quality of life, and poor categorization within the classification of the New York Heart Association. This, and other issues, has led most centres to abandon the atriopulmonary connection as a means of creating the Fontan circulation in favour of the lateral tunnel with cavopulmonary connections,6or the extracardiac conduit.7

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Heart Rate Variability in Children With Fontan Circulation: Lateral Tunnel and Extracardiac Conduit

Pediatric Cardiology ◽

10.1007/s00246-011-0126-2 ◽

2011 ◽

Vol 33 (2) ◽

pp. 307-315 ◽

Cited By ~ 11

Author(s):

Jenny Alenius Dahlqvist ◽

Marcus Karlsson ◽

Urban Wiklund ◽

Rolf Hörnsten ◽

Eva Strömvall-Larsson ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Fontan Circulation ◽

Extracardiac Conduit ◽

Lateral Tunnel

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Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2007.10.007 ◽

2008 ◽

Vol 41 (2) ◽

pp. 173-177 ◽

Cited By ~ 22

Author(s):

Nina Hakacova ◽

Miroslav Lakomy ◽

Lubica Kovacikova

Keyword(s):

Fontan Operation ◽

Extracardiac Conduit ◽

Lateral Tunnel

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Computational Model for the Study of Fontan Circulation

Advances in System Dynamics and Control - Advances in Systems Analysis, Software Engineering, and High Performance Computing ◽

10.4018/978-1-5225-4077-9.ch019 ◽

2018 ◽

pp. 587-606

Author(s):

Alejandro Talaminos-Barroso ◽

Laura María Roa-Romero ◽

Javier Reina-Tosina

Keyword(s):

Computational Model ◽

Cardiovascular System ◽

Fontan Procedure ◽

Fontan Operation ◽

Univentricular Heart ◽

Physiological Basis ◽

Hemodynamic Variables ◽

Extracardiac Conduit ◽

Lateral Tunnel ◽

Key Factor

In this chapter, the design and development of a computational model of the cardiovascular system is presented for patients who have undergone the Fontan operation. The model has been built from a physiological basis, considering some of the mechanisms associated to the cardiovascular system of patients with univentricular heart disease. Thus, the model allows the prediction of some hemodynamic variables considering different physiopathological conditions. The original conditions of the model are changed in the Fontan procedure and these new dynamics force the hemodynamic behaviours of the different considered variables. The model has been proved considering the classic Fontan procedure and the techniques from the lateral tunnel and the extracardiac conduit. The results compiled knowledge of several cardiovascular surgeons with many years of experience in such interventions, and have been validated by using other authors' data. In this sense, the participation of a multidisciplinary team has been considered as a key factor for the development of this work.

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