Key result
Extracardiac conduit Fontan linked to ~28% lower risk of composite outcomes vs lateral tunnel Fontan.
Why the study?
The extracardiac conduit and lateral tunnel are the most prevalent Fontan operation strategies, but their long-term comparative outcomes are unclear.
Does extracardiac conduit Fontan improve long-term outcomes compared to lateral tunnel Fontan in patients undergoing first-time Fontan operation?
Population
1290 propensity-matched patients undergoing first-time Fontan operation after 2000 in the FORCE registry
Comparison
Extracardiac conduit Fontan vs lateral tunnel Fontan
Design
Multicenter cohort study with propensity score matching
Follow-up
15 years
Authors
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May inform conduit selection in surgical planning; leaves open confirmation of benefit in randomized trials.
Cohort (n=3,072)
Yes
Does extracardiac conduit Fontan improve long-term outcomes compared to lateral tunnel Fontan in patients undergoing first-time Fontan operation?
Hazard Ratio: 0.72 (95% CI 0.54–0.96)
Absolute Event Rate: 19.8% vs 32.4%
p-value: p=0.0257
Extracardiac conduit Fontan is associated with a significantly lower risk of long-term atrial arrhythmias and composite morbidity compared to lateral tunnel Fontan at 15-year follow-up.
Seese et al. (2025) conducted a cohort in Single ventricle / Fontan operation (n=3,072). Extracardiac conduit (ECC) Fontan vs. Lateral tunnel (LT) Fontan was evaluated on Composite outcome including death, listing for transplantation, sustained atrial arrhythmias, emergent cardioversion, plastic bronchitis, protein-losing enteropathy, and catheter-based intervention (HR 0.72, 95% CI 0.54-0.96, p=0.0257). Extracardiac conduit Fontan was associated with a lower hazard of the composite Fontan outcome compared to lateral tunnel Fontan (19.8% vs 32.4%; HR 0.72; 95% CI 0.54-0.96; P=0.0257).
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