Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: the Australia and New Zealand Fontan Registry experience

Iyengar, Ajay J., Winlaw, David S., Galati, John C., Celermajer, David S., Wheaton, Gavin R., Gentles, Thomas L., Grigg, Leeanne E., Weintraub, Robert G., Bullock, Andrew, Justo, Robert N. and d'Udekem, Yves (2013) Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: the Australia and New Zealand Fontan Registry experience. Journal of Thoracic and Cardiovascular Surgery, 148 2: 566-575. doi:10.1016/j.jtcvs.2013.09.074

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Author Iyengar, Ajay J.
Winlaw, David S.
Galati, John C.
Celermajer, David S.
Wheaton, Gavin R.
Gentles, Thomas L.
Grigg, Leeanne E.
Weintraub, Robert G.
Bullock, Andrew
Justo, Robert N.
d'Udekem, Yves
Title Trends in Fontan surgery and risk factors for early adverse outcomes after Fontan surgery: the Australia and New Zealand Fontan Registry experience
Journal name Journal of Thoracic and Cardiovascular Surgery   Check publisher's open access policy
ISSN 0022-5223
1097-685X
1085-8687
Publication date 2013-11-23
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.jtcvs.2013.09.074
Open Access Status Not yet assessed
Volume 148
Issue 2
Start page 566
End page 575
Total pages 11
Place of publication Mosby
Publisher Philadelphia, PA, United States
Language eng
Abstract Objectives: This study examined changes in practice and analyzed risk factors for adverse early outcomes after Fontan surgery through use of a binational, population-based registry.
Formatted abstract
Objectives This study examined changes in practice and analyzed risk factors for adverse early outcomes after Fontan surgery through use of a binational, population-based registry.

Methods Demographic, preoperative, and perioperative data were collected from all participating institutions of the Australia and New Zealand Fontan Registry. Patient and operative characteristics were analyzed with multivariable logistic regression for impact on early mortality, early Fontan failure (death, takedown, or mechanical support), effusions (prolonging hospital stay >30 days or requiring surgical reintervention), and stay longer than 30 days.

Results Overall mortality was 3.5% (37/1071) and declined throughout the study period, from 8% (1975-1990) to 4% (1991-2000) and 1% (2001-2010). There were no differences between the extracardiac and lateral tunnel modifications for any outcome. After 2006, the extracardiac conduit was performed exclusively, with 1.3% mortality. The proportion of patients with hypoplastic left heart syndrome rose to 17% in the current era, and this group had more effusions (odds ratio, 3.0; 95% confidence interval, 1.4-6.6) and stayed on average 2 days longer in the hospital. Hypoplastic left heart syndrome was also an independent risk factor for composite adverse early outcome (death, failure, prolonged effusions, or prolonged stay >30 days; odds ratio, 2.6; 95% confidence interval 1.4-4.8 respectively).

Conclusions The extracardiac conduit is now the exclusive Fontan modification performed in Australia and New Zealand. Even with a higher proportion of high-risk cases, perioperative outcomes are excellent in the modern era. Hypoplastic left heart syndrome confers a higher risk of prolonged pleural effusion and early composite adverse outcome.
Keyword Cardiac & Cardiovascular Systems
Respiratory System
Surgery
Cardiovascular System & Cardiology
Respiratory System
Surgery
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID APP1012241
APP1038802
Institutional Status UQ
Additional Notes Available online 23 November 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 25 Apr 2014, 00:20:05 EST by Dominique Rossouw on behalf of School of Medicine