Predicting outcome after Fontan palliation: a single-centre experience, using simple clinical variables

Background The Fontan procedure has become the procedure of choice for patients with one functional ventricle. Although perioperative mortality has decreased, late failure of the Fontan circulation remains a major concern. We aimed at (i) describing Fontan patient characteristics and (ii) identifying simple risk factors for outcome. Methods Seventy-three patients (median age 2y (IQR 19-29 y), 60.3% male) were selected from the database of congenital heart defects. Followup data were collected. The primary end point was composed by death, resuscitation, or heart transplantation. Results The most frequently occurring defect was tricuspid atresia (41.1%). Twenty-five (34.2%) and 48 (65.8%) patients received an intra- and extracardiac conduit, respectively. Ten patients reached the primary end point (13.7%) after a median follow-up time of 16 years (IQR 14-19 y). NYHA classification (OR 63.0; 95% Cl 6.7-592.4; P <= 0.001), atrioventricular-valve regurgitation (OR 10.6; 95% Cl: 1.2-94.1; P= 0.034), ventricular function (OR 4.8; 95% Cl 1.7-13.7; P=0.003), oxygen saturation (OR 0.7; 95% Cl 0.1-1.0; P = 0.002) and the presence (OR 8.6; 95% Cl 1.6-45.2; P =0.011) or history of supraventricular arrhythmia (OR 6.7; 95% Cl: 1.3-35.0; P= 0.025), all parameters gathered at the latest follow-up, were associated with outcome. An association was also found with the presence of an intracardiac conduit (OR 5.8;95% Cl 1.4-25.1; P=0.018), higher age at Fontan procedure (OR 1.2; 95% Cl 1.0-1.3; P= 0.007) and male gender (OR 0.2; 95% Cl 0.1-1.0; P = 0.047). Conclusions Complications were not uncommon later after Fontan surgery. Several demographic and procedure-related data were associated with adverse outcome. Interestingly, the strongest correlation was found with clinical and basic echocardiographic characteristics at the latest follow-up.