FONTAN OPERATION IN 500 CONSECUTIVE PATIENTS - FACTORS INFLUENCING EARLY AND LATE OUTCOME

Objectives: The purpose of this study was to review a large, evolving, single-center experience with the Fontan operation and to determine r isk factors influencing early and late outcome, Methods: The first 500 patients undergoing modifications of the Fontan operation at our inst itution were identified, Perioperative variables were recorded and a c ross-sectional review of survivors was undertaken, Results: The incide nce of carry failure decreased from 27.1% in the first quartile of the experience to 7.5% in the last quartile, In a multivariate model, the following variables were associated with an increased probability of early failure: a mean preoperative pulmonary artery pressure of 19 mm Hg or more (p < 0.001), younger age at operation (p = 0.001), heterota xy syndrome (p = 0.03), a right-sided tricuspid valve as the only syst emic atrioventricular valve (p = 0.001), pulmonary artery distortion ( p = 0.04), an atriopulmonary connection originating at the right atria l body or appendage (p = 0.001), the absence of a baffle fenestration (p = 0.002), and longer cardiopulmonary bypass time (p = 0.001), An in creased probability of late failure was associated with the presence o f a pacemaker before the Fontan operation (p < 0.001), A morphological ly left ventricle with normally related great arteries or a single rig ht ventricle (excluding heterotaxy syndrome and hypoplastic left heart syndrome) were associated with a decreased probability of late failur e (p = 0.003). Conclusions: These analyses indicate that early failure has declined over the study period and that this decline is related i n part to procedural modifications, A continuing late hazard phase is associated with few patient-related variables and does not appear rela ted to procedural variables.