Ten-year outcomes of Fontan conversion in Australia and New Zealand demonstrate the superiority of a strategy of early conversion

Chin Leng Poh, Andrew Cochrane, John C. Galati, Andrew Bullock, David S. Celermajer, Tom Gentles, Karin du Plessis, David S. Winlaw, Tim Hornung, Kirsten Finucane, Yves d'Udekem

Research output: Contribution to journalArticle

Abstract

Objective: To investigate the benefits of a strategy of early Fontan conversion. 

Methods: Using the Australia and New Zealand Fontan Registry, retrospective analysis of their long-term follow-up data was performed. 

Results: Between 1990 and 2014, a total of 39 patients underwent surgical conversion in 6 centres at a median age of 23.8 years (IQR: 19.3-28.2), 18.7 ± 5.0 years post-Fontan. One centre tended to perform conversion earlier: Interval since first documented arrhythmia 2.9 ± 4.0 vs 4.0 ± 4.2 years, average NYHA Class 2 ± 0.4 vs 3 ± 0.9 (P = 0.008), mean number of preop anti-arrhythmics 1 ± 0.4 vs 2 ± 0.6 (P = 0.05). Two patients underwent conversion to an extracardiac conduit only, while 36 had concomitant right atrial cryoablation, of which 16 also had pacemaker implantation. Nine patients suffered major cardiac-related complications (7 low output syndrome, 3 ECMO, 3 acute renal failure, one stroke) (2/17 from the early conversion centre and 7/22 of the others; P = 0.14). Four patients died in hospital (10.3%) and 4 late after a median of 0.9 years [95% confidence interval (CI): 0.5-1] after conversion. An additional 2 patients needed transplantation at 1 and 8.8 years after conversion, respectively. The 10-year freedom from heart transplantation was 86% (95% CI: 51-97%). Outcomes from the centre with an early conversion strategy were significantly better: 8-year freedom from death or heart transplantation was 86% (95% CI: 53-96) vs 51% (95% CI: 22-74; log-rank P = 0.007). Eight additional patients required pacemaker implantation and 5 had arrhythmia recurrence. 

Conclusions: Fontan conversion is associated with lasting survival outcomes up to 10 years after conversion. A strategy of surgical conversion at earlier stage of failure may be associated with better survival free from transplantation.

Original languageEnglish
Article numberezv112
Pages (from-to)530-535
Number of pages6
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume49
Issue number2
DOIs
Publication statusPublished - Feb 2016
Externally publishedYes

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    Poh, C. L., Cochrane, A., Galati, J. C., Bullock, A., Celermajer, D. S., Gentles, T., du Plessis, K., Winlaw, D. S., Hornung, T., Finucane, K., & d'Udekem, Y. (2016). Ten-year outcomes of Fontan conversion in Australia and New Zealand demonstrate the superiority of a strategy of early conversion. European Journal of Cardio-Thoracic Surgery, 49(2), 530-535. [ezv112]. https://doi.org/10.1093/ejcts/ezv112