What question did this study set out to answer?

To evaluate mid-term survival and exercise capacity in patients undergoing modified Fontan operations with right atrial-to-right ventricular (RA-RV) versus right atrial-to-pulmonary artery (RA-PA) connections.

October 1, 1997European Journal of Cardio-Thoracic SurgeryOpen Access

Exercise capacity and mid-term survival in patients with tricuspid atresia and complex congenital cardiac malformations after modified Fontan-operation

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Why the study?

Does right atrial to right ventricular (RA-RV) anastomosis improve survival and exercise capacity compared to right atrial to pulmonary artery (RA-PA) connection in patients undergoing Fontan operation?

Population

191 patients with tricuspid atresia, single ventricle, or complex congenital cardiac malformations who…

Comparison

Right atrial to right ventricular anastomosis vs Right atrial to pulmonary artery connection

Design

Cohort

Follow-up

Up to 15 years for survival; median 6.0 to 7.8 years for…

Authors

JWJ. WeipertUniversity of Würzburg

Discussion

Member takes

Implication

Supports equivalence of connections; leaves open whether subpulmonary ventricle incorporation benefits contemporary or longer-term Fontan outcomes.

Key Points

To evaluate mid-term survival and exercise capacity in patients undergoing modified Fontan operations with right atrial-to-right ventricular (RA-RV) versus right atrial-to-pulmonary artery (RA-PA) connections.
Followed 191 surgical patients operated between 1980 and 1995, comprising 73 RA-RV (Fontan-Bjoerk) and 118 RA-PA connections, with a 97.9% follow-up rate.
Conducted bicycle ergospirometry and impedance cardiography during exercise in 15 RA-RV patients (median follow-up 6.0 years), 18 RA-PA patients (median follow-up 7.8 years), and 23 healthy controls.
Survival at 5, 10, and 15 years was 89.3 ± 3.6%, 76.8 ± 0.6%, and 63.6 ± 10.5% for RA-RV versus 80.2 ± 4.0%, 75.3 ± 4.5%, and 64.6 ± 10.7% for RA-PA connections (P = 0.12).
Total workload, heart rate, oxygen uptake, and ventilatory equivalent for oxygen did not differ significantly between Fontan groups, though both remained below normal control values.
Cardiac index and stroke volume index were consistently lower at the anaerobic threshold and peak exercise in RA-PA patients compared to healthy controls.

Structured PICO

Population

191 patients with tricuspid atresia, single ventricle, or complex congenital cardiac malformations who underwent modified Fontan-operation between 1980 and 1995. A subset of 33 patients and 23 healthy pupils underwent exercise testing.

Intervention

Right atrial to right ventricular (Fontan-Bjoerk, RA-RV) anastomosis

Comparator

Right atrial to pulmonary artery (RA-PA) connection

Outcome

Survival at 5, 10, and 15 yearshard clinical

Incorporation of a residual subpulmonary ventricular chamber (RA-RV connection) in the Fontan circulation provides no additional benefit for mid-term survival or exercise capacity compared to RA-PA connection.

Cite This Study

J. Weipert (1997) studied this question.

synapsesocial.com/papers/6a726fc0f44fa9f079dfeb8e https://doi.org/10.1016/s1010-7940(97)00220-0

Topics

Congenital heart disease adults

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Implication

Supports equivalence of connections; leaves open whether subpulmonary ventricle incorporation benefits contemporary or longer-term Fontan outcomes.

Exercise capacity and mid-term survival in patients with tricuspid atresia and complex congenital cardiac malformations after modified Fontan-operation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Exercise capacity and mid-term survival in patients with tricuspid atresia and complex congenital cardiac malformations after modified Fontan-operation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Topics

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