| Abstract [eng] |
The Fontan procedure has been modified several times since it was introduced into practice in 1968. As many patients now survive to adulthood, attention is directed towards their clinical status and late morbidity. From 1985 to 2015, 83 patients underwent Fontan surgery. Twenty-one patients received an atrio-pulmonary Fontan (Group I), four patients underwent total cavopulmonary connection (TCPC) with an intra-atrial lateral tunnel (Group II), six patients received extra-cardiac TCPC with an aortic homograft (group III) and 53 patients received extra-cardiac TCPC with an expanded polytetrafluoroethylene conduit. Patients were divided into two groups (Group A and B) depending on the age at Fontan procedure. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. The Kaplan–Meier estimated 15-year survival rate was 42% in Group I, 50% in Group II, 83% in Group III and 94% in Group IV. Fourteen (17%, 14/83) patients underwent redo Fontan procedures. Fontan modification as TCPC with an extracardiac GORE-TEX® conduit shows the best results. Fontan completion with an extracardiac GORE-TEX® conduit can be accomplished safe for patients under 3 years of age. Postoperative pleural effusion drainage is shorter for younger patients at Fontan completion ( p = 0.014). The long-term result should be followed. |
