Perioperative characteristics and early outcomes in patients with Fontan circulation compared with those with other forms of congenital heart disease
| Patients’ details | Fontan (n=34) | Other univentricular (n=27) | * | Biventricular (n=60) | † | ‡ | p Value |
|---|---|---|---|---|---|---|---|
| Age—median years, (IQR)§ | 17 (11–31) | 14 (5–24) | 0.065 | 20 (14–41) | 0.26 | 0.011 | 0.042 |
| Weight median kg (IQR)§ | 58 (26–73) | 32 (15–65) | 0.054 | 60 (38–74) | 0.45 | 0.005 | 0.007 |
| Univentricular | |||||||
| LV dominant | 19 (56) | 14 (52) | >0.99 | – | – | – | >0.99 |
| RV dominant | 15 (44) | 13 (48) | >0.99 | – | – | – | >0.99 |
| Hypoplastic left heart syndrome | 6 (18) | 7 (26) | 0.53 | – | – | – | 0.53 |
| Biventricular | |||||||
| TGA | – | – | – | 14 (23) | – | – | – |
| ccTGA | – | – | – | 10 (17) | – | – | – |
| TOF | – | – | – | 7 (12) | – | – | – |
| Ebstein’s anomaly | – | – | – | 4 (7) | – | – | – |
| Aortic stenosis | – | – | – | 4 (7) | – | – | – |
| Mitral regurgitation | – | – | – | 3 (5) | – | – | – |
| AVSD | – | – | – | 4 (7) | – | – | – |
| VSD | – | – | – | 9 (15) | – | – | – |
| Others¶ | – | – | – | 5 (8) | – | – | – |
| Days on waiting list—median (IQR)§ | 179 (112–499) | 130 (72–290) | 0.24 | 133 (62–307) | 0.087 | 0.79 | 0.89 |
| Previous cardiac surgery | 34 (100) | 24 (89) | 0.081 | 52 (87) | 0.047 | >0.99 | 0.089 |
| Number of prior surgeries—mean (SD)** | 2.7 (1.1) | 2.4 (1.7) | >0.99 | 1.9 (1.2) | 0.006 | 0.18 | 0.006 |
| Preoperative inotropes | 4 (12) | 3 (11) | >0.99 | 7 (12) | >0.99 | >0.99 | >0.99 |
| Preoperative VAD | 2 (6) | 0 (0) | 0.13 | 8 (13) | 0.32 | 0.054 | 0.094 |
| Preoperative creatinine (μmol/L)—mean (SD)** | 78 (42) | 56 (27) | 0.11 | 79 (51) | >0.99 | 0.043 | 0.038 |
| Operative | |||||||
| Cardiopulmonary bypass time—mean min (SD)** | 282 (99) | 209 (82) | 0.012 | 207 (93) | 0.001 | >0.99 | 0.001 |
| Ischaemic time—mean min (SD)** | 291 (91) | 230 (92) | 0.064 | 233 (100) | 0.022 | >0.99 | 0.016 |
| Great artery reconstruction | 19 (56) | 10 (37) | 0.20 | 0 (0) | <0.001 | <0.001 | <0.001 |
| Aortic arch reconstruction | 3 (9) | 3 (11) | >0.99 | 0 (0) | 0.045 | 0.035 | 0.041 |
| Pulmonary artery repair/reconstruction | 18 (53) | 7 (26) | 0.04 | 0 (0) | <0.001 | <0.001 | <0.0001 |
| Early outcomes | |||||||
| In-hospital mortality | 2 (6) | 4 (15) | 0.39 | 5 (8) | >0.99 | 0.45 | 0.46 |
| Primary graft failure | 4 (12) | 4 (15) | >0.99 | 10 (17) | 0.76 | >0.99 | 0.81 |
| Stroke | 1 (3) | 1 (4) | >0.99 | 3 (5) | >0.99 | >0.99 | 0.88 |
| Renal impairment | 11 (32) | 5 (19) | 0.25 | 14 (23) | 0.35 | 0.78 | 0.43 |
| Post-transplant ECMO | 5 (15)†† | 3 (11) | >0.99 | 8 (13) | >0.99 | >0.99 | 0.92 |
| Post-transplant IABP | 3 (9) | 2 (7) | >0.99 | 7 (12) | 0.74 | 0.71 | 0.80 |
Categorical variables displayed as number (percentage).
*Comparison between Fontan and other univentricular repairs.
†Comparison between Fontan and biventricular repairs.‡Comparison between other univentricular and biventricular repairs.
§Compared using non-parametric statistical testing.
**Compared using parametric statistical testing.
¶Others: these five patients had: truncus arteriosus, tricuspid dysplasia, VSD with partial Uhl’s anomaly, partial anomalous pulmonary venous drainage, anomalous left main coronary artery.
††One patient was placed on ECMO due to septic shock despite intact graft function.
AVSD, atrioventricular septal defect; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; IQR, interquartile range; LV: left ventricle; RV: right ventricle; TGA, transposition of the great arteries; ccTGA, congenitally corrected TGA; TOF, tetralogy of Fallot; VAD, ventricular assist device; VSD, ventricular septal defect;.