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Long-term outcome and anaesthetic management for non-cardiac surgery after Fontan palliation: a single-centre retrospective analysis

Published online by Cambridge University Press:  23 September 2014

Thomas Palumbo ,
Thierry Sluysmans ,
Jean E. Rubay ,
Alain J. Poncelet  and
Mona Momeni
Thomas Palumbo
Affiliation:
Department of Anesthesiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Thierry Sluysmans
Affiliation:
Department of Pediatric Cardiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Jean E. Rubay
Affiliation:
Department of Cardiac Surgery; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Alain J. Poncelet
Affiliation:
Department of Cardiac Surgery; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
Mona Momeni*
Affiliation:
Department of Anesthesiology; Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
*
Correspondence to: M. Momeni, MD, PhD, Department of Anesthesiology, Cliniques Universitaires Saint Luc, Avenue Hippocrate 10/1821, 1200 Brussels, Belgium. Tel: +322 764 7029; Fax: +322 764 3699; E-mail: mona.momeni@uclouvain.be
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Abstract

Objectives: The improved management of Fontan patients has resulted in good outcome. As such, these patients may necessitate care for non-cardiac surgery. We sought to determine the long-term outcome of our Fontan series palliated with the most recent surgical techniques. Our second objective was to report the incidence and the perioperative course after non-cardiac procedures. We reviewed the records of all patients with either a lateral tunnel or an extracardiac conduit Fontan between 1996 and 2008. Follow-up was recorded until June, 2013, including records regarding non-cardiac interventions. Results: Overall, 58 patients were included. Of them, one patient underwent a takedown of his Fontan, and five patients died in the immediate postoperative course. The cumulative survival of the remaining 52 patients was 81%. There was no significant difference in survival between right and left ventricle morphologies (p=0.56), nor between both types of Fontan (p=0.9). Chronic arrhythmias (25%), fatigue/dyspnoea (40%), thrombotic complications (19%), and embolic events (10%) were among the most recurrent comorbidities. In total, 45 non-cardiac interventions were performed on 26 patients, with three bleeding complications and one death. Conclusions: This study shows excellent long-term survival after both lateral tunnel and extracardiac conduit Fontan. The incidence of cardiovascular morbidity remains high, however. We also report a high number of non-cardiac interventions. Thorough understanding of the Fontan physiology is mandatory when non-cardiac anaesthesiologists are in charge of these patients.

Keywords

Fontanlong-term outcomenon-cardiac intervention
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 6 , August 2015 , pp. 1148 - 1154
Copyright
© Cambridge University Press 2014 

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