CLINICAL STUDY: PEDIATRIC CARDIOLOGY
The Fontan procedure for tricuspid atresia: early and late results of a 25-year experience with 216 patients
Douglas D. Mair, MD, FACC*,
Francisco J. Puga, MD, FACC and
Gordon K. Danielson, MD, FACC
* Section of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received June 21, 2000;
revised manuscript received September 20, 2000,
accepted November 3, 2000.
Reprint requests and correspondence: Dr. Douglas D. Mair, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
mair.douglas{at}mayo.edu
OBJECTIVES
We assessed the operative and late mortality and the present clinical status of 216 patients with tricuspid atresia who had a nonfenestrated Fontan procedure performed at the Mayo Clinic in the 25-year period 1973 to 1998.
BACKGROUND
The Fontan operation eliminates the systemic hypoxemia and ventricular volume overload characteristic of prior forms of palliation. However, it originally did so at the cost of systemic venous and right atrial hypertension, and the long-term effects of this "price" were unknown when the procedure was initially proposed.
METHODS
We reviewed the clinical records of the 216 patients retrospectively. These were arbitrarily grouped into early (1973 through 1980), middle (1981 through 1987) and late (1988 through 1997) surgical eras. Patient outcome was also analyzed according to age at surgery. Operative and late mortality rates were determined and present clinical status was ascertained in 167 of 171 surviving patients.
RESULTS
Overall survival was 79%. Operative mortality steadily declined and was 2% (one of 58 patients) during the most recent decade. Late survival also continues to improve. Age at operation had no effect on operative mortality, and late mortality was significantly increased only in patients who were operated on at age 18 years or older. Eighty-nine percent of surviving patients are currently in New York Heart Association class I or II.
CONCLUSIONS
The initial 25-year experience with the nonfenestrated Fontan procedure for tricuspid atresia has been gratifying, with most survivors now leading lives of good quality into adulthood. These results justify continued application of this procedure for children born with tricuspid atresia.
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Abbreviations and Acronyms
| | LV | = left ventricular | | NYHA | = New York Heart Association | | PA | = pulmonary artery | | RA | = right atrium | | RV | = right ventricle, right ventricular |
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