Key result
The presence of an additional secondary ventricle in Fontan circulation was not associated with significant differences in early complications (23.9% vs 18.9%; P=0.53) or late survival.
Why the study?
The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data.
Does the presence of an additional ventricular chamber affect early and long-term clinical outcomes in patients with a functional single ventricle undergoing the Fontan operation?
Cohort (n=210)
No
Does the presence of an additional ventricular chamber affect early and long-term clinical outcomes in patients with a functional single ventricle undergoing the Fontan operation?
Absolute Event Rate: 23.9% vs 18.9%
p-value: p=0.53
The presence of a secondary diminutive ventricle in patients undergoing the Fontan operation does not significantly impact long-term survival or complication rates compared to univentricular Fontan.
Additional secondary ventricle does not worsen Fontan outcomes; leaves open effects on function or arrhythmias in prospective cohorts.
OBJECTIVES: The role of an additional ventricle in patients with a functional single ventricle undergoing the Fontan operation has been debated due to conflicting data. Our goal was to report our experience with Fontan circulation for complex congenital heart disease, with a focus on the influence that an additional ventricular chamber may have on early and long-term clinical outcomes. METHODS: We performed a retrospective clinical study including all patients undergoing the Fontan procedure between 1978 and 2019. Clinical data were retrieved from our institutional database. A 'biventricular' Fontan (BVF) was defined as that performed in a patient with single ventricle anomaly where an additional diminutive ventricular cavity was present at echocardiographic evaluation. RESULTS: A total of 210 consecutive patients with functional single ventricle were included. Among these, 46 had BVF (21.9%). Early complications occurred in 42 patients (20.0%; 11 in BVF vs 31 in univentricular Fontan; P = 0.53) There were 18 early deaths (8.6%) with no difference between the groups. At a median follow-up of 12.7 years (interquartile range 5.4-20.7), there were no significant differences in late mortality, whereas cardiac rhythm disturbances resulted more frequently in univentricular Fontan (P = 0.018). Statistical analysis showed an equal distribution of BVF across time (P = 0.620), and there were no significant differences in terms of early and late survival (P = 0.53 and P = 0.72, respectively) or morbidity (P = 0.45 and P = 0.80, respectively). CONCLUSIONS: A secondary ventricle in Fontan circulation is not significantly related to any clinical disadvantage in terms of survival or onset of complications. However, the immediate postoperative course may be influenced negatively by the presence of an additional secondary ventricle.
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Rossi et al. (2021) conducted a cohort in Functional single ventricle (n=210). Biventricular Fontan (presence of an additional diminutive ventricular cavity) vs. Univentricular Fontan was evaluated on Early complications (p=0.53). The presence of an additional secondary ventricle in Fontan circulation was not associated with significant differences in early complications (23.9% vs 18.9%; P=0.53) or late survival.
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