Long-term outcomes following Fontan takedown in Australia and New Zealand

Supreet P. Marathe, Ajay J. Iyengar, Kim S. Betts, Karin du Plessis, Gananjay G. Salve, Robert N. Justo, Prem Venugopal, David S. Winlaw, Yves d'Udekem, Nelson Alphonso*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objective: Fontan takedown remains an option for the management of Fontan failure. We sought to evaluate early and late outcomes after Fontan takedown. Methods: The Australia and New Zealand Fontan Registry was interrogated to identify all patients who had a Fontan takedown. Results: Over a 43-year study period (1975-2018), 36 of 1540 (2.3%) had a Fontan takedown. The median age at takedown was 5.1 years (interquartile range [IQR], 3.7, 7.0). Nine (25%) patients had a takedown within 48 hours, 6 (16%) between 2 days and 3 weeks, 14 (39%) between 3 weeks and 6 months, whereas 7 (19%) had a late takedown (>6 months). Median interval to takedown was 26 days (IQR, 1.5, 127.5). Sixteen (44%) patients died at a median of 57.5 days (IQR, 21.8, 76.8). The greatest mortality occurred between 3 weeks and 6 months (<2 days: 1/9, 11%; 2 days to 3 weeks: 2/6, 33%; 3 weeks to 6 months: 11/14, 79%; >6 months: 2/7, 28%; P = .007). At median follow-up of 9.4 years (IQR, 4.5, 15.3), 11 (31%) patients were alive with an intermediate circulation (10 in New York Heart Association class I/II). Five (14%) patients underwent a successful second Fontan. Freedom from death/transplant after Fontan takedown was 59%, 56%, and 52% at 1, 5, and 10 years, respectively. Conclusions: The incidence of Fontan takedown is low, but mortality is high. The majority of takedowns occurred within 6 months. Mortality was lowest when takedown occurred <2 days and highest between 3 weeks and 6 months. A second Fontan is possible in a small proportion of survivors.

Original languageEnglish (US)
Pages (from-to)1126-1135
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume161
Issue number3
DOIs
StatePublished - Mar 2021

Funding

The Australia & New Zealand Fontan Registry is partly funded by a National Health and Medical Research Council partnership grant (1076849) . Professor D'Udekem is a Clinician Practitioner Fellow of the NHMRC (1082186). The authors acknowledge their research teams for their support in maintaining the Australian & New Zealand Fontan Registry and the support provided to the Murdoch Children's Research Institute by the Victorian Government's Operational Infrastructure Support Program.

Keywords

  • Fontan failure
  • Fontan palliation
  • Fontan takedown
  • single-ventricle palliation

ASJC Scopus subject areas

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

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