COMPARATIVE-ASSESSMENT OF FONTAN OPERATION IN MODIFICATIONS OF ATRIOPULMONARY AND TOTAL CAVOPULMONARY ANASTOMOSES

Objectives: The optimal technique of the Fontan operation remains disp utable. This investigation was aimed at the comparison of atriopulmona ry and total cavopulmonary anastomoses. Methods: The results of 81 ope rations of total cavopulmonary and 69 operations of atriopulmonary ana stomosis, performed from 1983 to 1995 were analysed. A control study w as carried out 1-10 (3.7 + 0.2) years after the operation in 80 patien ts (36 after total cavopulmonary and 44 after atriopulmonary anastomos es). 70 patients were studied several times. Cardiac catheterization w as done in 70 patients. In 78 patients central hemodynamical indices w ere studied during exercise. Results: Preoperative hemodynamical indic es were not reliably different in the two groups. Early mortality afte r total cavopulmonary anastomosis was 15%, after atriopulmonary anasto mosis 23%. The highest mortality was seen when the criteria of Choussa t et al. (Choussat et al. Pediatric Cardiology. Edinburgh: 1977:559-56 6) were surpassed. In the early postoperative period after total cavop ulmonary anastomosis circulatory insufficiency was less marked, transs udation from pleural cavities was reliably lower (15.3 + 1.2 versus 25 .5 + 1.8 ml/kg/day, P < 0.01). Arrhythmias were more common after tota l cavopulmonary anastomosis (18.5 versus 12%). Late mortality after to tal cavopulmonary anastomosis was 6%, after atriopulmonary anastomosis 12%. 82% of patients after atriopulmonary anastomosis and 81% after t otal cavopulmonary anastomosis were in NYHA classes 1 and 2.7% of pati ents after total cavopulmonary anastomosis and 11% after atriopulmonar y anastomosis were reoperated. Physical tolerance rose stepwise in bot h groups and by the third post-operative year reached 75% of normal le vel. At this time we saw the most optimal hemodynamical indices during exercise. However, the best hemodynamics during exercise were seen af ter atriopulmonary anastomosis. Conclusions: Total cavopulmonary anast omosis is accompanied by lower mortality rate and a more favourable co urse of early postoperative period. However, the best long-term functi onal results are obtained after atriopulmonary anastomosis. (C) 1997 E lsevier Science B.V.