Long-term results of the lateral tunnel Fontan operation

Objectives: Completion of a total cavopulmonary anastomosis with an intraat rial lateral tunnel is known to yield good early and midterm results. In th is study, we sought to determine the long-term outcome (10 years) after a l ateral tunnel Fontan procedure. Methods: Between October 1987 and December 1991, 220 patients (aged 11 mont hs to 32 years) with a wide range of underlying diagnoses underwent a fenes trated or nonfenestrated lateral tunnel Fontan procedure at our institution . Current follow-up information was available for 196 patients (94%, mean f ollow-up = 10.2 +/- 0.6 years). Risk factor analysis included patient-relat ed and procedure-related variables, with death, failure, and bradyarrhythmi a or tachyarrhythmia as outcome parameters. Results: There were 12 early deaths (<30 days or hospital death), 7 late de aths, 4 successful takedown operations, and 4 heart transplantations. Kapla n-Meier estimated survival was 93% at 5 years and 91% at 10 years, and free dom from failure was 90% at 5 years and 87% at 10 years. Freedom from new s upraventricular tachyarrhythmia was 96% at 5 years and 91% at 10 years; fre edom from new bradyarrhythmia was 88% at 5 years and 79% at 10 years. Three patients had evidence of protein-losing enteropathy. Multivariable risk fa ctors for development of supraventricular tachyarrhythmia included heterota xy syndrome, atrioventricular valve abnormalities, and preoperative bradyar rhythmia. Risk factors for bradyarrhythmia included systemic venous anomali es. The sole risk factor for late failure was a previous coarctation repair . Conclusion: The lateral tunnel Fontan procedure results in excellent long-t erm outcome even when used in patients with diverse anatomic diagnoses. The incidence of atrial tachyarrhythmia is low and mainly depends on the under lying cardiac morphology and preoperative arrhythmia. The good long-term ou tcome after an intracardiac lateral tunnel Fontan procedure should serve as a basis for comparison with other surgical alternatives.