Predictors of unfavourable early outcome following Fontan completion

Background

In spite of the magnificent improvement in Fontan operation results in the last two decades, there are still some concerns regarding the unfavourable early outcomes that may follow Fontan completion.

Methods

From 2003 to 2016, 79 patients underwent Fontan operation at IRCCS Policlinico San Donato. Unfavourable early outcome was defined by the presence of one or more of these occurrences: prolonged hospital stay >25 days, prolonged pleural effusion ≥14 days and prolonged inotropic support ≥72 h. Univariable and multivariable analyses were performed to detect the risk factors associated with early unfavourable outcome after Fontan completion.

Results

Prolonged hospital stay >25 days was found in 24.05% of patients and its associated significant risk factors were low preoperative O₂ saturation (p 0.007), Fontan fenestration (p 0.009) and plasma transfusion (p 0.030). Prolonged pleural effusion ≥14 days was found in 24.05% and no significant risk factors were detected. Prolonged inotropic support ≥72 h was found in 35.44% and significant risk factors were prolonged cardiopulmonary bypass (CPB) time (P 0.003), fenestration (P 0.023), plasma transfusion (P 0.028) and non staged Fontan (P 0.039). In multivariable analysis of combined unfavourable outcome, significant risk factors were fenestration (P 0.030) with some trends towards low preoperative O₂ saturation (P 0.056).

Conclusions

Unfavourable early outcome can occur following Fontan completion with associated prolonged hospital stay. Risk factors include low preoperative O₂ saturation, prolonged CPB time, Fontan fenestration, plasma transfusion and non staged Fontan.