135MANAGEMENT OF EARLY FONTAN FAILURE: A SINGLE-INSTITUTION EXPERIENCE

Objectives: To analyse the incidence and outcomes of early Fontan failure (EFF) in a contemporary cohort of palliated patients. Methods: A retrospective, single-centre study of all patients undergoing primary Fontan from 1 July 1995 to 31 December 2009 was performed. EFF was defined as death, need for extracorporeal membrane oxygenation (ECMO), Fontan takedown to superior cavopulmonary connection or transplantation within 30 days of the Fontan procedure. The incidence and outcomes were summarized with descriptive statistics, and risk factors for EFF were identified. Results: Five-hundred and ninety-two patients underwent primary Fontan procedure; 67% had a dominant right ventricle. An extracardiac conduit (ECC) was used for Fontan completion in 61% with the remainder having a lateral tunnel. EFF occurred in 11 patients (1.9%), all of whom had an ECC. ECMO was used in five patients, five had Fontan takedown, and two had transplantation. Five of 11 study subjects died (46%) as opposed to an overall mortality for primary Fontan of 0.8%. Among patients who had Fontan takedown, long-term survival was 80%. By univariate analysis, elevated ventricular end-diastolic pressure (9.5 ± 3.3 vs 7.4 ± 2.7 mmHg, P = 0.02), and total circulatory support time (99 ± 33 vs 71 ± 23 min, P = 0.0001) were risk factors for EFF. At a mean follow-up of 5.9 years, there was one late transplant-related death. Of the four surviving patients who had Fontan takedown, three underwent subsequent Fontan and one underwent biventricular repair. Conclusions: EFF is rare in the current era, but associated with significant mortality. High filling pressures and prolonged intraoperative course are risk factors for EFF. Of the management strategies available, Fontan takedown appears to be associated with the best outcomes.