The Clinical Outcome of Patients Undergoing Fontan Surgery; Over 10 Years of Experience in a Single Center

Background: The modified Fontan operation is one of the essential surgical techniques in children with congenital heart diseases. Thus, we sought to identify the characteristics as well as the early and late outcomes of patients who have undergone Fontan operation during more than 10 years. Methods: The medical records of 52 patients who underwent modified Fontan operation from March 21th, 2006 to March 20th, 2018, at Tabriz Children's Hospital including the baseline, clinical and surgical data were extracted and reviewed. Patients were invited for follow up visits and clinical examination and echocardiographic evaluations were conducted. Findings: The most prevalent heart anomaly was tricuspid valve disorders (28 cases, 51.9%). The majority of patients (42 cases, 80.2 %) underwent intracardiac lateral tunnel Fontan. The most prevalent complications were prolonged pleural effusion and neurologic events (each one in 10 cases, 19.2%). The in-hospital mortality rate was 15.3%. The patients were followed for a median of 7 years. The survival of those successfully followed was 75 percent. The most common valvular disorder was mitral valve regurgitation (MR), which was present in 84% of cases. The group of patients with single ventricle had a significantly higher mortality rate than the other groups (P = 0.018). Conclusion: Survival rate of patients undergoing a Fontan completion is acceptable. However, patients remain at risk for morbid events. Moreover, patients with Fontan circulation should be strictly followed to investigate the development of MR and to timely repair in severe cases to prevent further deterioration. Of note, due to some limitations of our study, further multi-centric studies are required to confirm our findings.