The Fontan procedure for tricuspid atresia: Early and late results of a 25-year experience with 216 patients

OBJECTIVES We assessed the operative and late mortality and the present cli nical status of 216 patients with tricuspid atresia who had a nonfenestrate d Fontan procedure performed at the Mayo Clinic in the 25-year period 1973 to 1998. BACKGROUND The Fontan operation eliminates the systemic hypoxemia and ventr icular volume overload characteristic of prior forms of palliation. However , it originally did so at the cost of systemic venous and right atrial hype rtension, and the long-term effects of this "price" were unknown when the p rocedure was initially proposed. METHODS We reviewed the clinical records of the 216 patients retrospectivel y. These were arbitrarily grouped into early (1973 through 1980), middle (1 981 through 1987) and late (1988 through 1997) surgical eras. Patient outco me was also analyzed according to age at surgery. Operative and late mortal ity rates were determined and present clinical status was ascertained in 16 7 of 171 surviving patients. RESULTS Overall survival was 79%. Operative mortality steadily declined and was 2% tone of 58 patients) during the most recent decade. Late survival a lso continues to improve. Age at operation had no effect on operative morta lity, and late mortality was significantly increased only in patients who w ere operated on at age 18 years or older. Eighty-nine percent of surviving patients are currently in New York Heart Association class I or II. CONCLUSIONS The initial 25-year experience with the nonfenestrated Fontan p rocedure for tricuspid atresia has been gratifying, with most survivors now leading lives of good quality into adulthood. These results justify contin ued application of this procedure for children born with tricuspid atresia. CT Am Coil Cardiol 2001;37:933-9) (C) 2001 by the American College of Card iology.