Differences between Fontan and TCPC procedures based on adult patients’ long-term outcome
█ Original article
Pataki Szabina, Sárkány Beatrix, Szegedi Margit, Takács Edit, Fischer Szilvia, Környei László, Ablonczy László, Andréka Péter, Temesvári András, Bálint Olga Hajnalka
Gottsegen György Kardiologiai Intézet, 1096 Budapest, Haller utca 29.
Background: The Fontan surgery is a palliative procedure in patients with univentricular heart performed as the classic right atrial to pulmonary connection (RA-PA), or total cavopulmonary connection (TCPC). The non-pulsatile venosus circulation leads to the insufficiency of the venous circulation, known as Failing Fontan. This condition represents an indication for heart transplantation (HTX).
Aims: To evaluate the long-term outcomes of adult patients after Fontan/TCPC procedure, and compare the clinical outcomes of Fontan and TCPC populations.
Methods: Patients were enrolled who underwent Fontan/TCPC operation between 2001–2017 at our Institute with a follow-up at least 1 year and complications were assessed.
Results: 73 Fontan/TCPC patients were enrolled in our study (Fontan: n=18, TCPC: n=55). TCPC was carried out in substantially younger patients as compared to traditional Fontan procedure (7.4±6.9 vs. 12.3±7.0 years; p<0.05). The mean follow-up time was 22.3±5.9 years after Fontan, and 17.8±3.8 years after TCPC surgery. The following complications were registered during follow-up: 16,4% had heart failure, 32.8% had arrhythmias, 15.1% thromboembolic events, 21.9% had liver cirrhosis and 5.4% had protein-losing enteropathy. Compared with TCPC, Fontan patients presented with a higher rate of atrial arrhythmia (p=0.005) and hospitalization for heart failure (p=0.026). Failing Fontan was observed in 16.4% of patients (Fontan: 22.2%, TCPC 14.5%; p=0.44). During the study period 4 patients died, and 2 were transplanted (no difference was found in regard to these events and type of surgery).
Conclusion: Despite of younger age, patients with Fontan/TCPC operation are at high risk for morbidities. The Fontan surgery – when compared with TCPC seems to carry a higher risk for atrial arrhythmias and heart failure requiring hospitalization. The patient’s age at operation was a predictor of Failing Fontan.