J. Maxwell Chamberlain memorial paper for congenital heart surgery111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes
Section snippets
Patients and Methods
This is a retrospective clinical study of 111 consecutive patients who underwent Fontan conversion with arrhythmia surgery between December 1994 and November 2006. This study was approved by the Institutional Review Board of Children’s Memorial Hospital as a retrospective analysis; the need for patient consent was waived.
Results
Table 1, Table 2, Table 3 show the emergence of an increasingly complex patient population. In a comparison of groups I and II versus group III, three trends are apparent: increased incidence of concomitant surgical repairs (p = 0.03); older patients (p = 0.01); and increased incidence of left atrial reentry tachycardia and atrial fibrillation necessitating performance of Cox-maze III operations (p = 0.04). The mean postoperative hospital stay for all patients was 13.7 ± 12.1 days (group I, 8.7
Comment
This clinical review confirms the favorable outcome of Fontan conversion with arrhythmia surgery for patients with tricuspid atresia and atriopulmonary connections published earlier by us [1, 2, 5] and others [7, 14, 15]. Importantly, this series demonstrates the efficacy of this surgery for patients with increasingly complex anatomic lesions, and atrial fibrillation or left atrial tachycardia. In this challenging population, we have demonstrated continued low mortality and excellent arrhythmia
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Cited by (157)
Adults with Congenital Heart Disease and Arrhythmia Management
2020, Cardiology Clinics2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
2019, Journal of the American College of CardiologySuccessful atrial fibrillation ablation without pulmonary vein isolation utilizing focal impulse and rotor mapping in an atriopulmonary Fontan
2018, HeartRhythm Case ReportsCitation Excerpt :Since its introduction in 1971, the surgical techniques have evolved considerably.1 Early atriopulmonary (AP) versions of the Fontan incorporated the right atrium (RA) into the systemic venous circuit and are associated with considerable burden of early and late atrial dysrhythmias.1–5 Although the majority of atrial arrhythmias are macroreentrant RA circuits, such as intra-atrial reentrant tachycardia (IART), the prevalence of late atrial fibrillation (AF) in Fontan patients is increasing.2,4–7
Winner of the J. Maxwell Chamberlain Memorial Award for Congenital Heart Surgery.