Fontan Failure and Death in Contemporary Fontan Circulation

Analysis From the Last Two Decades

Yasuhiro Kotani, Devin Chetan, Jiaquan Zhu, Arezou Saedi, Lisa Zhao, Luc Mertens, Andrew N. Redington, John Coles, Christopher A. Caldarone, Glen S. Van Arsdell, Osami Honjo

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: We sought to evaluate the incidence of Fontan failure or complication and its relation to death in patients having contemporary Fontan strategies over 2 decades. Methods: Five hundred patients who underwent Fontan completion (extracardiac, n = 326; lateral tunnel, n = 174) from 1985 to 2012 were reviewed. Patient characteristics, modes of Fontan failure/complication and death, and predictors for Fontan failure/complication and death were analyzed. Results: There were 23 early deaths (4.6%) and 17 late deaths (3.4%), with no early death since 2000. Survival has improved over time (p < 0.001). Twenty-three of 40 patients who died were identified as Fontan failure before death, including ventricular dysfunction (n = 14), pulmonary vascular dysfunction (n = 4), thromboembolism (n = 2), and arrhythmia (n = 4). Mode of death was circulatory failure (n = 18), multiorgan failure (n = 6), pulmonary failure (n = 3), cerebral/renal (n = 5), and sudden death (n = 4). Modes of failure/complication were directly (65%) or conceivably (10%) related to death in 30 of 40 patients (75%). Forty-eight percent of survivors had late Fontan complication(s). Five-year freedom from late Fontan complication was lower among patients who died compared with patients who survived (29.4% versus 53.3%, p < 0.001). Ventricular dysfunction (p = 0.001) and higher pulmonary artery pressures (p < 0.001) after Fontan were predictors for death. Longer cardiopulmonary bypass time (p = 0.032) and reinterventions (p < 0.001) were predictors for late Fontan complication. Conclusions: Early death in the early era has been overcome. Yet the incidence and causes of late death remain unchanged. There was a strong causative relationship between the mode of Fontan failure/complication and death, indicating the importance of early recognition and treatment of Fontan failure/complication.

Original languageEnglish
Pages (from-to)1240-1247
Number of pages8
JournalAnnals of Thoracic Surgery
Volume105
Issue number4
DOIs
Publication statusPublished - Apr 1 2018
Externally publishedYes

Fingerprint

Ventricular Dysfunction
Lung
Thromboembolism
Incidence
Sudden Death
Treatment Failure
Cardiopulmonary Bypass
Pulmonary Artery
Blood Vessels
Survivors
Cardiac Arrhythmias
Cause of Death
Shock
Kidney
Pressure
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Fontan Failure and Death in Contemporary Fontan Circulation : Analysis From the Last Two Decades. / Kotani, Yasuhiro; Chetan, Devin; Zhu, Jiaquan; Saedi, Arezou; Zhao, Lisa; Mertens, Luc; Redington, Andrew N.; Coles, John; Caldarone, Christopher A.; Van Arsdell, Glen S.; Honjo, Osami.

In: Annals of Thoracic Surgery, Vol. 105, No. 4, 01.04.2018, p. 1240-1247.

Research output: Contribution to journalArticle

Kotani, Y, Chetan, D, Zhu, J, Saedi, A, Zhao, L, Mertens, L, Redington, AN, Coles, J, Caldarone, CA, Van Arsdell, GS & Honjo, O 2018, 'Fontan Failure and Death in Contemporary Fontan Circulation: Analysis From the Last Two Decades', Annals of Thoracic Surgery, vol. 105, no. 4, pp. 1240-1247. https://doi.org/10.1016/j.athoracsur.2017.10.047
Kotani, Yasuhiro ; Chetan, Devin ; Zhu, Jiaquan ; Saedi, Arezou ; Zhao, Lisa ; Mertens, Luc ; Redington, Andrew N. ; Coles, John ; Caldarone, Christopher A. ; Van Arsdell, Glen S. ; Honjo, Osami. / Fontan Failure and Death in Contemporary Fontan Circulation : Analysis From the Last Two Decades. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 4. pp. 1240-1247.
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abstract = "Background: We sought to evaluate the incidence of Fontan failure or complication and its relation to death in patients having contemporary Fontan strategies over 2 decades. Methods: Five hundred patients who underwent Fontan completion (extracardiac, n = 326; lateral tunnel, n = 174) from 1985 to 2012 were reviewed. Patient characteristics, modes of Fontan failure/complication and death, and predictors for Fontan failure/complication and death were analyzed. Results: There were 23 early deaths (4.6{\%}) and 17 late deaths (3.4{\%}), with no early death since 2000. Survival has improved over time (p < 0.001). Twenty-three of 40 patients who died were identified as Fontan failure before death, including ventricular dysfunction (n = 14), pulmonary vascular dysfunction (n = 4), thromboembolism (n = 2), and arrhythmia (n = 4). Mode of death was circulatory failure (n = 18), multiorgan failure (n = 6), pulmonary failure (n = 3), cerebral/renal (n = 5), and sudden death (n = 4). Modes of failure/complication were directly (65{\%}) or conceivably (10{\%}) related to death in 30 of 40 patients (75{\%}). Forty-eight percent of survivors had late Fontan complication(s). Five-year freedom from late Fontan complication was lower among patients who died compared with patients who survived (29.4{\%} versus 53.3{\%}, p < 0.001). Ventricular dysfunction (p = 0.001) and higher pulmonary artery pressures (p < 0.001) after Fontan were predictors for death. Longer cardiopulmonary bypass time (p = 0.032) and reinterventions (p < 0.001) were predictors for late Fontan complication. Conclusions: Early death in the early era has been overcome. Yet the incidence and causes of late death remain unchanged. There was a strong causative relationship between the mode of Fontan failure/complication and death, indicating the importance of early recognition and treatment of Fontan failure/complication.",
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AU - Kotani, Yasuhiro

AU - Chetan, Devin

AU - Zhu, Jiaquan

AU - Saedi, Arezou

AU - Zhao, Lisa

AU - Mertens, Luc

AU - Redington, Andrew N.

AU - Coles, John

AU - Caldarone, Christopher A.

AU - Van Arsdell, Glen S.

AU - Honjo, Osami

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