Key result
Systemic right ventricles in extracardiac Fontan patients led to higher early morbidity, including increased need for dialysis (21% vs 4%, P=0.003), compared to systemic left ventricles.
Why the study?
Does systemic right ventricular morphology worsen early postoperative outcomes in patients undergoing extracardiac Fontan operation compared to systemic left ventricular morphology?
Cohort (n=173)
Does systemic right ventricular morphology worsen early postoperative outcomes in patients undergoing extracardiac Fontan operation compared to systemic left ventricular morphology?
Patients with a systemic right ventricle undergoing extracardiac Fontan operation experience higher early postoperative morbidity and require more intensive management compared to those with a systemic left ventricle.
May warrant intensified perioperative monitoring in systemic RV Fontan patients; leaves open whether morphology should guide selection or technique.
Objectives: We aimed to compare early postoperative outcome after extracardiac (EC) Fontan operation between patients with right (RV) or left (LV) systemic ventricles. Methods: In total, 173 consecutive patients (median age 4 years, median weight 14 kg) underwent EC Fontan between 1995 and 2013. Pre- and intraoperative data as well as detailed postoperative haemodynamic variables were compared between patients with LV [ n = 109 (63%)] and RV [ n = 64 (37%)]. Results: : RV patients showed significantly lower mean arterial (median 55 vs 59 mmHg, P = 0.04), higher atrial (median 8 vs 6 mmHg, P = 0.03) and comparable pulmonary pressure (median 14 vs 14 mmHg, P = 0.7) as well as lower mean systemic perfusion pressure (median 39 vs 43 mmHg, P = 0.03) on Day 0 after EC Fontan. They suffered from longer intubation time (median 18 vs 12 h, P = 0.008), higher incidence of ascites (46% vs 28%, P = 0.04) and need for dialysis (21% vs 4%, P = 0.003). Prolonged inotropic support (25% vs 8%, P = 0.02) and pharmacological treatment to reduce pulmonary vascular resistance (71% vs 53%, P = 0.002) were more often used in RV patients and they showed more often supraventricular tachyarrhythmia (27% vs 5%, P < 0.001) and a longer intensive care unit-stay (median 4 vs 3 days, P = 0.03). However, early mortality, need for Fontan takedown, use of mechanical circulatory support, pleural effusions and hospital stay were not significantly different between both groups. Conclusions: Patients with systemic RV demonstrate higher morbidity in the early postoperative course compared with patients with systemic LV anatomy and require intensified postoperative management to avoid postoperative Fontan failure.
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Nordmeyer et al. (2016) conducted a cohort in Single ventricle physiology requiring extracardiac Fontan operation (n=173). Systemic right ventricle anatomy vs. Systemic left ventricle anatomy was evaluated on Need for dialysis (p=0.003). Systemic right ventricles in extracardiac Fontan patients led to higher early morbidity, including increased need for dialysis (21% vs 4%, P=0.003), compared to systemic left ventricles.
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