Comparison of outcomes following the Fontan procedure between patients with previous ductus stent and aortopulmonary shunt.

Abstract

Objective: In this study, we aimed to compare the outcome after the Fontan procedure in patients after an initial ductus stenting or a surgical aortopulmonary shunt.

Methods: We reviewed infants with single ventricle and ductal-dependent pulmonary blood flow who underwent ductus stenting or an aortopulmonary shunt between 2009 and 2022, and subsequently underwent the staged Fontan procedure.

Results: A total of 93 patients were included (39 ductus stenting and 54 aortopulmonary shunts). Before the Fontan procedure, pulmonary artery pressure (9 vs. 9 mmHg, p = 0.376) and pulmonary artery index (184 vs. 183 mm2/m2, p = 0.988) were similar between the groups. However, the incidence of venovenous collaterals was higher in patients after ductus stenting than those after aortopulmonary shunt (35.9 vs. 16.7%, p = 0.034). Median age (1.9 vs. 1.8 years, p = 0.493) and weight at the Fontan procedure (12 vs. 11kg, p = 0.596) were similar between the groups. There was no in-hospital mortality in each group. The length of the intensive care unit stay (median 5 vs. 5 days, p = 0.542) and hospital stay (median 17 vs. 14 days, p = 0.767) were similar between the groups. During the median follow-up of 2.5 years, one late death was observed in the DS group. Freedom from reintervention (66.6 vs. 82.0%, p = 0.095) and from adverse events (78.6 vs. 92.2%, p = 0.488) at 5 years were similar between the groups.

Conclusions: This pilot study demonstrated comparable outcomes following the Fontan procedures between patients with single ventricle and ductal-dependent pulmonary blood flow after initial ductus stenting and those after initial aortopulmonary shunt.