Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation

Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5 years (IQR 3.3-6.4), median weight 16 kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4 years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4 years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.

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Journal
Pediatric Cardiology
Published
2024-09-17
DOI
https://doi.org/10.1007/s00246-024-03642-2
Citations
5
Primary Topic
Congenital Heart Disease Studies
Type
article
Field-Weighted Citation Impact
1.93
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article

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation

Gaetano Gargiulo, Ermanno Bellanti, Carlo Pace Napoleone, Vladimiro Lorenzo Vida et al.
5 citations
Pediatric Cardiology
Congenital Heart Disease Studies
1.93
article

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone? Early Outcomes After Fontan Operation

Gaetano Gargiulo, Ermanno Bellanti, Carlo Pace Napoleone, Vladimiro Lorenzo Vida, Luca Vedovelli, Giuseppe Scrascia, Alvise Guariento, Alessandro Giamberti, Gianfranco Butera, Massimo Antonio Padalino, Irene Cao, Mauro Lo Rito, Emma Bergonzoni, Lucio Careddu, Salvatore Agati, Halkawt Nuri, Fabio Scattolin, Anna Gozzi, Gabriele Scalzo, Rossana Zanoni, Roberta Biffanti, Emanuela Angeli, Ugo Vairo, Guido Michielon, Lorenzo Galletti, Stefano Marianeschi, Giovanni Meliota, Matteo Trezzi, Luca De Orsola, Giulia Guerra, Giovanni Di Salvo, Mario Panebianco
article en
5 citations

Abstract

Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Primary outcome was cohort's mortality, also considering different decades, while secondary outcomes were postoperative complications and reintervention. In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5 years (IQR 3.3-6.4), median weight 16 kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4 years was associated with an early need for transcatheter reintervention (adj p value = 0.037) and a higher incidence of postoperative complications (adj p value = 0.017). The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4 years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.

Pediatric CardiologyVol. 46(7)
University of Padua (IT), Istituto Giannina Gaslini (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), IRCCS Policlinico San Donato (IT), Azienda USL di Bologna (IT), Adult Congenital Heart Association (US), Bambino Gesù Children's Hospital (IT), Ospedale Regina Margherita (IT), Ospedale Pediatrico Giovanni XXIII (IT), University of Bari Aldo Moro (IT)
Good health and well-being
Openalex Percentile: Top 13%
Congenital Heart Disease Studies
1.93
DOIOpen Access PDFOpenAlex
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