Impact of Ventricular Morphology on Clinical Outcome After Fontan Palliation

Wonkyung Pyo

Asan Medical Center, Seoul, Republic of Korea, Seoul, Korea (South)

Date, time and location: 2018.05.25 13:30, Press Hall, 2F

Abstract

Object: Structure of right ventricle and tricuspid valve has been known to be less equipped to support systemic circulation. We hypothesized that clinical outcome after Fontan palliation in right dominant single ventricle groups is not inferior to that of left dominant single ventricle group.

Method: BetweenMay 1993, and May 2017, 302 functional single ventricle patients with RV or LV dominance underwent Fontan palliation. Patients with balanced two ventricles were excluded. We compared perioperative outcome and late complications after Fontan palliation. Cumulative incidence rates were estimated by the Kaplan-Meir method and compared by the log-rank test.

Results: Follow-up was complete in all patients at a mean of 107.8 months and the median age of study population was 3.3 years. There was no significant perioperative Fontan complication including early mortality and length of ICU or hospital stay. The 10-year over-all survival rate of LV and RV group was 96.4% and 91.3%, respectively (p=0.40). Fontan-failure-free survival rate was 93.1% in LV group and 88.6% in RV group at 10 year (p=0.33). The rate of freedom from unplanned reoperation at 10 year in each LV and RV groups was 97.6% and 92.6% (p=0.58). However, rate of post-natal freedom from AVV dysfunction showed statistically notable difference; 95.2% in LV group and 88.3% in RV group with p-value of 0.025.

Conclusion: There was no statistically significant difference in over-all survival, Fontan failure-free survival or rate of freedom from unplanned reoperation. Right dominant single ventricle group had higher incidence of significant tricuspid insufficiency which may necessitate surgical intervention.