Indication criteria for total cavopulmonary anastomosis

Objectives: In a retrospective study we evaluated the predictive value of t he traditional risk factors (Fontan criteria) for mortality and morbidity a fter total cavopulmonary anastomosis (Fontan operation). Design: We studied 51 consecutive patients who underwent Fontan operations from 1982 through 1994. Morbidity was assessed by a score taking equally in to account rhythm disturbances, cardiovascular hospital admissions and hear t failure. Results: The mean age at operation was 4.1 +/- 3.4 years. Diagnoses were tr icuspid atresia in 20, complex single ventricle in 13 acid various complex congenital heart defects in 18 patients. All Fontan criteria were fulfilled in 11 patients while in the remaining 40 up to 6 criteria were not met. Th e criteria least fulfilled were age in 31 patients and pulmonary artery ana tomy in 11. The mean follow-up was 4.6 +/- 3.0 years. The overall 30-day su rvival was 84% and 1- and 10-year survival 76.5% respectively. All patients who fulfilled all the Fontan criteria survived. The overall mortality and early mortality were associated with a significantly higher number of unful filled Fontan criteria (p <0.01). Age below 2 years at operation and pulmon ary resistance >4 Woods units were risk factors for overall mortality (p <0 .01). The number of unmet Fontan criteria was not significantly different i n patients with and without postoperative late morbidity. Conclusion: The Fontan criteria are reliable predictors for mortality but h ave little predictive value for morbidity. Surviving patients who do not fu lfil all criteria suggest that some criteria may need to be modified. Our l imited data support a lower age limit of 2 instead of 4 years.