Among patients who undergo the Fontan procedure, two-thirds of survivors require a surgical or catheter-based procedure within 20 years. Paediatric cardiology researchers note that doctors should counsel families about the likelihood of re-interventions.
“Unfortunately, for many patients, the Fontan is not the final intervention,” says study leader Andrew Glatz. Glatz is a paediatric interventional cardiologist in the Cardiac Center at Children’s Hospital of Philadelphia (CHOP, Philadelphia, USA).
The study team performed a retrospective review of 773 patients who underwent the Fontan operation at CHOP between 1992 and 2009.
Although the Fontan procedure offers high survival rates for a previously terminal, it cannot provide normal blood circulation. Risks of long-term complication continue to be analysed. Clinicians and researchers are aware of the need for re-interventions in long-term survivors, but there is a paucity of detailed knowledge of re-intervention rates in the literature.
Almost two-thirds of Fontan procedure patients underwent re-intervention
In the current study, the researchers found that 65% of Fontan survivors underwent a re-intervention by 20 years post-procedure. A median time to first re-intervention was slightly less than 10 years. The re-interventions were either operations or catheterisations, with catheterisations being more common. Among operations, the most common were to place or revise a pacemaker.
“The important message from this work is that…the Fontan operation is not the ‘final’ procedure, as it is sometimes [called]. Instead, many patients require further interventions after the Fontan to continue to try to optimise circulation as best as possible. It is important for families and doctors to understand this, so that expectations are clear. This also highlights the need for close and careful ongoing follow-up after the Fontan operation by paediatric cardiologists familiar with potential complications that could befall a Fontan patient,” says Glatz.
Glatz and colleagues published their results in Circulation: Cardiovascular Interventions.