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| Ventricular performance in long-term survivors after Fontan operation | ||||||||||||||||||||||||||||||
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Yuki Nakamura, Toshikatsu Yagihara, Kouji Kagisaki, Ikuo Hagino, Shuichi Shiraishi, Junjiro Kobayashi, Soichiro Kitamura; Cardiothoracic Surgery, National Cardiovascular Center, Suita, Osaka, Japan Objective: Long-term ventricular performance after Fontan operation has not been elucidated in detail. This study evaluated ventricular function and arrhythmia in patients with Fontan circulation for more than 15 years. Methods: We retrospectively reviewed 110 patients who underwent Fontan operation from 1979 to 1992. Forty eight patients in survivors who have been able to be followed up for more than 15 years were included in this study. Atriopulmonary connection (APC) was performed in 26 patients, and total cavopulmonary connection (TCPC) in 22 patients. We divided patients into 3 groups based on ventricular morphology: right ventricle (RV) group (n = 21), left ventricle (LV) group (n = 24), and biventricle group (n = 3). Follow-up cardiac catheterization was carried out routinely 1, 5, 10, and 15 years after the operation, and cardiac index (CI [l/min/m2]), ejection fraction (EF [%]), end-diastolic volume (EDV [% of normal]) , and end-diastolic pressure (EDP [mmHg]) were employed for the assessment. Mean age at Fontan operation was 6.1 ± 4.3 years. Three patients who required APC conversion to TCPC within 15 years were excluded for the comparison between the groups. Results: Mean follow-up was 18.5 ± 3.2 years (15 ~ 27.8): 20.1 ± 3.4 years (15.8 ~ 27.8) in APC group and 16.5 ± 1.4 years (15 ~ 19.7) in TCPC group. Table 1 indicates data of postoperative cardiac catheterization. EDV at 1 year was significantly larger than at 5, 10, 15 years (p < .05). EDP at 1 year was significantly lower than at 5, 10, 15 years (p < .001). CI was significantly higher in TCPC group than in APC group at 10 years (p = .045) and 15 years (p = .040). EF was higher in LV group than in RV group at 1 year (p = .042), 5 years (p = .007), 10 years (p = .136), and 15 years (p = .061). Beyond 15 years after Fontan operation, six patients suffered from ventricular tachycardia (VT) (12.5%): four in APC group at 15, 22, 22 and 24 years (3 of tricuspid atresia, 1 of double inlet LV), and two in TCPC group at 16 and 19 years (both of right isomerism heart). In comparison between the patients with and without VT, VT group revealed significantly higher operative age (10.5 ± 4.3 vs. 5.5 ± 4.0, p = 0.003). Conclusion: Long-term follow-up of Fontan operation demonstrated stability of hemodynamic parameters after 5 years. The advent of VT was recognized 15 years after the operation in higher age patients at the procedure, which might become a key event in further longer periods. Table 1: Postoperative cardiac catheterization
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