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

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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.

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

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ASJC Scopus subject areas

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

Cite this

Kotani, Y., Chetan, D., Zhu, J., Saedi, A., Zhao, L., Mertens, L., Redington, A. N., Coles, J., Caldarone, C. A., Van Arsdell, G. S., & Honjo, O. (2018). Fontan Failure and Death in Contemporary Fontan Circulation: Analysis From the Last Two Decades. Annals of Thoracic Surgery, 105(4), 1240-1247. https://doi.org/10.1016/j.athoracsur.2017.10.047