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

Early outcomes Fontan Operative survival Single ventricle Surgical palliation Univentricular heart

Journal

Pediatric cardiology
ISSN: 1432-1971
Titre abrégé: Pediatr Cardiol
Pays: United States
ID NLM: 8003849

Informations de publication

Date de publication:
17 Sep 2024
Historique:
received: 17 04 2024
accepted: 01 09 2024
medline: 17 9 2024
pubmed: 17 9 2024
entrez: 17 9 2024
Statut: aheadofprint

Résumé

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.

Identifiants

DOI: 10.1007/s00246-024-03642-2 PMID: 39287667
pubmed: 39287667
doi: 10.1007/s00246-024-03642-2
pii: 10.1007/s00246-024-03642-2
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Irene Cao (I)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Emma Bergonzoni (E)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Luca Vedovelli (L)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Giulia Guerra (G)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Lorenzo Galletti (L)

Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Rome, Italy.

Gianfranco Butera (G)

Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Rome, Italy.

Matteo Trezzi (M)

Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Rome, Italy.

Mario Panebianco (M)

Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Pediatric Hospital Bambino Gesù, Rome, Italy.

Gaetano D Gargiulo (GD)

Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy.

Emanuela Angeli (E)

Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy.

Lucio Careddu (L)

Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy.

Rossana Zanoni (R)

Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria Bologna, Bologna, Italy.

Carlo Pace Napoleone (C)

Pediatric and Congenital Cardiac Surgery, Regina Margherita Children's Hospital, Turin, Italy.

Luca De Orsola (L)

Pediatric and Congenital Cardiac Surgery, Regina Margherita Children's Hospital, Turin, Italy.

Alvise Guariento (A)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Fabio Scattolin (F)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Alessandro Giamberti (A)

Department of Pediatric and Adult Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.

Mauro Lo Rito (M)

Department of Pediatric and Adult Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.

Stefano M Marianeschi (SM)

Pediatric Cardiac Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Salvatore Agati (S)

Department of Congenital Heart Surgery and Pediatric Cardiology Mediterranean Congenital Heart Center, "Bambino Gesù"-San Vincenzo Hospital, Taormina, Italy.

Ermanno Bellanti (E)

Department of Congenital Heart Surgery and Pediatric Cardiology Mediterranean Congenital Heart Center, "Bambino Gesù"-San Vincenzo Hospital, Taormina, Italy.

Ugo Vairo (U)

Department of Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, Bari, Italy.

Giovanni Meliota (G)

Department of Pediatric Cardiology, Giovanni XXIII Pediatric Hospital, Bari, Italy.

Gabriele Scalzo (G)

Department of Pediatric Sciences, Pediatric Cardiac Surgery Unit, Giovanni XXIII Pediatric Hospital, Bari, Italy.

Giuseppe Scrascia (G)

Department of Pediatric Sciences, Pediatric Cardiac Surgery Unit, Giovanni XXIII Pediatric Hospital, Bari, Italy.

Halkawt Nuri (H)

Congenital Heart Surgery and Heart Centre, Gaslini Children's Hospital, Genoa, Italy.

Guido Michielon (G)

Congenital Heart Surgery and Heart Centre, Gaslini Children's Hospital, Genoa, Italy.

Roberta Biffanti (R)

Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua, Padua, Italy.

Anna Gozzi (A)

Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua, Padua, Italy.

Giovanni Di Salvo (G)

Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua, Padua, Italy.

Vladimiro L Vida (VL)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Massimo A Padalino (MA)

Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. massimo.padalino@uniba.it.
Pediatric and Congenital Cardiac Surgery, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari "Aldo Moro", Bari, Italy. massimo.padalino@uniba.it.

Classifications MeSH