OUTCOME AFTER THE SINGLE-STAGE, NONFENESTRATED FONTAN PROCEDURE

Background A completed Fontan circulation is the goal in the managemen t of patients with single-ventricle physiology. To achieve this end, a two-stage rather than a single-stage approach is carried out routinel y at many centers. Some groups have advocated baffle fenestration for virtually all patients to minimize post-Fontan complications. Other ce nters perform single-stage Fontan operations and do not fenestrate. Th us controversies have arisen regarding the indications for the staged procedure versus single stage and for fenestration versus no fenestrat ion. Methods and Results The preoperative risk factors and postoperati ve course were characterized in 61 consecutive patients (median age, 3 .3 years) undergoing a single-stage, nonfenestrated Fontan. The patien ts were followed for 3.5 +/- 1.9 years. The relationship between preop erative risk factors and mortality and morbidity was assessed. Preoper ative risk factors assessed included age < 2 years (n = 18), branch pu lmonary artery stenosis (n = 20), elevated mean pulmonary artery press ure > 15 mm Hg (n = 16), atrioventricular valve regurgitation (n = 5), and decreased ventricular function (n = 2). Total caval pulmonary ana stomosis was performed in 53 patients. Additional surgery was required at the time of the Fontan in 25 patients (41%). The median duration o f mechanical ventilation was 1 day; median chest tube drainage was 5.5 days (range, 1 to 35). Oxygen saturation rose significantly postopera tively, from 83% to 95%. Early mortality was 4.9%; one patient died fr om pacemaker failure 9 months postoperatively, and one patient underwe nt successful heart transplant 4 months post-Fontan. One- and 5-year a ctuarial survival was 93%. No preoperative risk factor was associated with a failed Fontan or significant effusions. Conclusions A single-st age, nonfenestrated Fontan was performed in a large group of patients with excellent surgical results and intermediate outcome. There is no evidence that a two-stage approach and/or baffle fenestration is requi red for a large cohort of patients who are candidates for a Fontan ope ration.