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Impact of Time Interval Between Glenn and Fontan Procedures on Fontan Operative and Long-Term Follow-up Results

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Abstract

Objective

The bidirectional cavopulmonary shunt (BCPS) is an effective palliative procedure which has been widely used to boost outcome of the Fontan procedure. However, there is no standard duration time between these two procedures. Therefore, we investigated whether different time intervals between BCPS and Fontan procedure affects morbidity and mortality of Fontan patients.

Methods

Between 2004 and 2016, 210 post-BCPS patients underwent Fontan operation at Fuwai Hospital. The median interval between BCPS and Fontan procedure was 3.7 years (range 0.55–11.86 years) and this was used to divide study cohort into Group 1 (< 3.7 years; n = 124) and Group 2 (> 3.7 years; n = 86). We analyzed these patients retrospectively in terms of their preoperative characteristics and post-operative and follow-up results.

Results

Weight z-scores for age at BCPS (− 0.73 ± 1.39 vs − 1.17 ± 1.60, p < 0.05) was significantly higher in Group 2. However, saturation at room air before Fontan (76.42 ± 20.01 vs 82.85 ± 9.69, p < 0.001) was significantly higher in Group 1. The morbidity and mortality were similar between two groups. There were twelve hospital deaths (5.7%): eight (8/124, 6.5%) presented in Group 1 and four (4/86, 4.7%) in Group 2. On multi-variable analysis, risk factors for death were prolonged mechanical ventilation [hazard ratio (HR) 1.02, p = 0.004] and single right ventricle (HR 7.17, p = 0.03). After a mean follow-up of 4.95 years (range 0.74–13.62 years), one patient in Group 1 died of heart failure 13 months after Fontan procedure. The overall Fontan failure in Group 1 was similar to that in Group 2 (2.7% vs 2.6%, p = 0.985). The incidence of arrhythmias and re-intervention were not different between the two groups.

Conclusions

Fontan procedure could be performed safely in patient who stayed in long duration between Fontan procedure and BCPS without affecting the operative and long-term follow-up results. However, for post-BCPS patients with severe hypoxemia, earlier age at Fontan might be a good choice.

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Acknowledgements

We gratefully acknowledge the role of all our colleagues, perfusionists, nurses, and others involved in the care of the study patients.

Funding

Funding for this study was provided by a grant from the Natural Science Foundation of China (NSFC, 81370273).

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Author notes

  1. Tong Yi and Guohui Fan have contributed equally to this work.

Authors and Affiliations

  1. Department of Congenital Heart Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, China

    Tong Yi, Yunchao Xing, Wei Zhao, Liang Zhang, Xianchao Jiang, Zhiling Ma, Jun Yan, Shoujun Li & Qiang Wang

  2. Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China

    Guohui Fan

  3. Center for Infant Heart, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Fan Fan

Authors
  1. Tong Yi
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  2. Guohui Fan
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  3. Yunchao Xing
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  4. Wei Zhao
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  5. Liang Zhang
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  6. Fan Fan
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  7. Xianchao Jiang
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  8. Zhiling Ma
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  9. Jun Yan
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  10. Shoujun Li
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  11. Qiang Wang
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Corresponding author

Correspondence to Qiang Wang.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients, parents, or guardians included in the study.

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Cite this article

Yi, T., Fan, G., Xing, Y. et al. Impact of Time Interval Between Glenn and Fontan Procedures on Fontan Operative and Long-Term Follow-up Results. Pediatr Cardiol 40, 705–712 (2019). https://doi.org/10.1007/s00246-018-2049-7

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  • DOI: https://doi.org/10.1007/s00246-018-2049-7

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