20 years of experience with the Fontan procedure: Risk factors for adverse outcomes.

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Revista Portuguesa De Cardiologia Pub Date : 2025-09-10 DOI:10.1016/j.repc.2025.04.006

Tianyu Chen, Linjiang Han, Hailong Qiu, Zewen Chen, Jianzheng Cen, Shusheng Wen, Jimei Chen, Xiaobing Liu, Jian Zhuang

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引用次数: 0

Abstract

Introduction and objectives: The Fontan procedure and the management of patients with univentricular physiology have undergone significant evolution over the past five decades. However, the long-term outcomes of these patients remain not fully understood. This study aimed to evaluate the early and long-term outcomes of patients undergoing the Fontan procedure and to identify risk factors associated with adverse clinical events.

Methods: Patients who underwent the Fontan procedure between 2004 and 2023 were included in this study. Multivariable logistic regression analysis was employed to assess risk factors for early mortality, while a Cox proportional hazards regression model was used to evaluate predictors of long-term Fontan failure.

Results: A total of 400 patients were included, with a male predominance (67.3%). Median age at the time of the Fontan procedure was 5.8 years (interquartile range: 4.1-11.0 years). The distribution of ventricular morphology was as follows: dominant right ventricle (33%), dominant left ventricle (35.75%), and two well-developed ventricles (28.75%). The early mortality rate was 5.5%. The overall survival rates at 5-, 10-, and 15-years post-Fontan surgery were 97.5%, 92.6%, and 90.0%, respectively. Multivariable analysis identified asplenia (odds ratio [OR], 10.2; 95% confidence interval [CI], 2.8-36.4; p<0.01), single-stage total cavopulmonary connection (OR, 5.3; 95% CI, 1.7-16.8; p<0.01), and prolonged cardiopulmonary bypass time (OR, 1.0; 95% CI, 1.0-1.0; p<0.01) as significant predictors of early mortality. Cox regression analysis demonstrated that heterotaxy (hazard ratio [HR], 3.5; 95% CI, 1.4-8.7; p<0.01) was an independent risk factor for late Fontan failure.

Conclusion: The staged Fontan strategy was associated with reduced early mortality but did not confer significant benefits on long-term outcomes. Patients with heterotaxy were at an increased risk of late Fontan failure, highlighting the need for tailored management strategies in this high-risk population.

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20年的丰坦手术经验：不良后果的危险因素。

前言和目的：在过去的五十年里，Fontan手术和单心室生理患者的管理经历了重大的演变。然而，这些患者的长期预后仍不完全清楚。本研究旨在评估接受Fontan手术的患者的早期和长期预后，并确定与不良临床事件相关的危险因素。方法：2004年至2023年间接受Fontan手术的患者纳入本研究。采用多变量logistic回归分析评估早期死亡的危险因素，采用Cox比例风险回归模型评估长期Fontan失效的预测因素。结果：共纳入400例患者，男性居多（67.3%）。Fontan手术时的中位年龄为5.8岁（四分位数范围：4.1-11.0岁）。心室形态分布：右心室优势（33%），左心室优势（35.75%），两个心室发育良好（28.75%）。早期死亡率为5.5%。fontan手术后5年、10年和15年的总生存率分别为97.5%、92.6%和90.0%。多变量分析发现，脾功能不全（优势比[OR]， 10.2； 95%可信区间[CI]， 2.8-36.4; p < 0.01）、单期全腔肺连接（OR, 5.3; 95% CI, 1.7-16.8; p < 0.01）和延长体外循环时间（OR, 1.0; 95% CI, 1.0-1.0; p < 0.01）是早期死亡的重要预测因素。Cox回归分析显示，异质性（风险比[HR]为3.5；95% CI为1.4 ~ 8.7;p < 0.01）是晚期Fontan衰竭的独立危险因素。结论：分阶段Fontan策略与降低早期死亡率相关，但对长期预后没有显著益处。异位患者晚期Fontan失败的风险增加，突出了在这一高危人群中定制管理策略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista Portuguesa De Cardiologia CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.70

自引率

22.20%

发文量

205

审稿时长

54 days

期刊介绍： The Portuguese Journal of Cardiology, the official journal of the Portuguese Society of Cardiology, was founded in 1982 with the aim of keeping Portuguese cardiologists informed through the publication of scientific articles on areas such as arrhythmology and electrophysiology, cardiovascular surgery, intensive care, coronary artery disease, cardiovascular imaging, hypertension, heart failure and cardiovascular prevention. The Journal is a monthly publication with high standards of quality in terms of scientific content and production. Since 1999 it has been published in English as well as Portuguese, which has widened its readership abroad. It is distributed to all members of the Portuguese Societies of Cardiology, Internal Medicine, Pneumology and Cardiothoracic Surgery, as well as to leading non-Portuguese cardiologists and to virtually all cardiology societies worldwide. It has been referred in Medline since 1987.