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Fontan conversion with concomitant arrhythmia surgery for the failing atriopulmonary connections: mid-term results from a single centre

Published online by Cambridge University Press:  27 May 2011

Anuradha Sridhar
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Alessandro Giamberti*
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Sara Foresti
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Riccardo Cappato
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Carlos Rubio-Iglesias García
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Nerea Delgado Cabrera
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Angelo Micheletti
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Diana Negura
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Claudio Bussadori
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Gianfranco Butera
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Alessandro Frigiola
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Mario Carminati
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
Massimo Chessa
Affiliation:
Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Cardiovascular Center ‘E. Malan’, University of Milan, San Donato Milanese, Milan, Italy
*
Correspondence to: Dr A. Giamberti, Department of Pediatric Cardiology & Adult with Congenital Heart Disease, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato M.se, Milan, Italy. Tel: +39 02 52774 531; Fax: +39 02 52774459; E-mail: massimo.chessa@grupposandonato.it

Abstract

Objectives

Classical Atriopulmonary Fontan connections tend to fail in the long term due to progressive anastomotic site obstruction, right atrial enlargement, and refractory atrial arrhythmias. Conversion to total cavopulmonary connection with concomitant arrhythmia surgery is a promising treatment but optimal timing of the procedure remains controversial.

Methods

Between the years 2002 and 2009, 15 patients with a median age of 26.2 (12–43) years underwent Fontan conversion operation with concomitant arrhythmia surgery. All were symptomatic and 14 out of the 15 patients had refractory arrhythmias. The duration of pre-operative arrhythmia and the outcome of surgery were correlated to study the impact of delay in surgical intervention on post-operative survival and arrhythmia control.

Results

There were two patients who died in the early post-operative period (13.3%). At the mid-term follow-up, 53 (20–86) months, late atrial arrhythmias had recurred in two of the 13 surviving patients (15.30%) and one patient developed late sinus node dysfunction. The need for anti-arrhythmic drugs decreased considerably from 93.5% to 15.3% on mid-term follow-up. There was no late death or need for cardiac transplantation. The duration of arrhythmia before surgery was prolonged for more than 10 years in patients who died as well as in those who had complications like late recurrence of arrhythmias, dependence on anti-arrhythmic medications, and worsening of ventricular dysfunction.

Conclusions

Fontan conversion is a well-established treatment option for salvaging the failing atriopulmonary connections. Concomitant arrhythmia surgery effectively resolves the refractory atrial arrhythmias and improves survival, but we need to optimise the timing of Fontan conversion to improve the long-term outcome.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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