Congenital heart disease
Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: The Australia and New Zealand Fontan Registry experience

https://doi.org/10.1016/j.jtcvs.2013.09.074Get rights and content
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Objectives

This study examined changes in practice and analyzed risk factors for adverse early outcomes after Fontan surgery through use of a binational, population-based registry.

Methods

Demographic, preoperative, and perioperative data were collected from all participating institutions of the Australia and New Zealand Fontan Registry. Patient and operative characteristics were analyzed with multivariable logistic regression for impact on early mortality, early Fontan failure (death, takedown, or mechanical support), effusions (prolonging hospital stay >30 days or requiring surgical reintervention), and stay longer than 30 days.

Results

Overall mortality was 3.5% (37/1071) and declined throughout the study period, from 8% (1975-1990) to 4% (1991-2000) and 1% (2001-2010). There were no differences between the extracardiac and lateral tunnel modifications for any outcome. After 2006, the extracardiac conduit was performed exclusively, with 1.3% mortality. The proportion of patients with hypoplastic left heart syndrome rose to 17% in the current era, and this group had more effusions (odds ratio, 3.0; 95% confidence interval, 1.4-6.6) and stayed on average 2 days longer in the hospital. Hypoplastic left heart syndrome was also an independent risk factor for composite adverse early outcome (death, failure, prolonged effusions, or prolonged stay >30 days; odds ratio, 2.6; 95% confidence interval 1.4-4.8 respectively).

Conclusions

The extracardiac conduit is now the exclusive Fontan modification performed in Australia and New Zealand. Even with a higher proportion of high-risk cases, perioperative outcomes are excellent in the modern era. Hypoplastic left heart syndrome confers a higher risk of prolonged pleural effusion and early composite adverse outcome.

CTSNet classification

20
41.1

Abbreviations and Acronyms

CI
confidence interval
HLHS
hypoplastic left heart syndrome
IQR
interquartile range
OR
odds ratio

Cited by (0)

Supported by the Victorian Government's Operational Infrastructure Support Program. The Australia and New Zealand Fontan Registry is funded by grants from the NHMRC (APP1012241) Heart Kids and the ANZ Bank Trustees. Y.d'U. is a Career Development Fellow of The National Heart Foundation of Australia (CR 10M 5339). A.J.I. has received postgraduate awards from the Royal Australasian College of Surgeons (Catherine Marie Enright Kelly and Eric Bishop Scholarships) and the National Health and Medical Research Council (NHMRC) and The National Heart Foundation of Australia (APP1038802).

Disclosures: Andrew Bullock reports consulting fees from Actelion. All other authors have nothing to disclose with regard to commercial support.