18 years of the Fontan operation at a single institution: Results from 771 consecutive patients

Lindsay S. Rogers, Andrew C. Glatz, Chitra Ravishankar, Thomas L. Spray, Susan C. Nicolson, Jack Rychik, Christina Hayden Rush, J. William Gaynor, David J. Goldberg

Research output: Contribution to journalArticlepeer-review

141 Scopus citations


Objectives: The aim of this study was to evaluate Fontan peri-operative outcomes for 771 consecutive patients. Background: Since the initial description by Fontan, mortality associated with the Fontan operation has declined substantially. However, postoperative effusions remain a significant challenge. Effusions are a key determinant of postoperative length-of-stay and have been shown to be associated with the development of protein-losing enteropathy and with decreased survival. Methods: This study was a single-center, retrospective review of 771 patients who underwent Fontan palliation from 1992 to 2009. Results: Patients were divided into 3 eras dictated by shift in clinical practice. Overall mortality was 3.5%, 1% since 1996. Importantly, age at Stage II palliation decreased from Era 1 to Era 3 (7.1 vs. 5.9 months; p = 0.0001), whereas age at Fontan increased (1.7 vs. 2.8 years; p = 0.0001). The proportion of patients with prolonged hospital stay (46.7% vs. 8.2% vs. 19.5%, p < 0.001) decreased substantially after Era 1. A diagnosis of hypoplastic left heart syndrome and longer operative support times were associated with prolonged pleural drainage (odds ratio [OR]: 2.17, p < 0.001; OR: 1.2, p = 0.001) and hospital stay (OR: 1.48, p = 0.05; OR: 1.34, p < 0.001). In patients who underwent invasive assessment, higher pulmonary artery pressure was associated with death (OR: 1.37, p < 0.001) and prolonged hospital stay (OR: 1.09, p = 0.019). Pulmonary arterial pressure <15 mm Hg was 90% specific for discriminating unfavorable outcomes. Conclusions: Mortality in the modern era is rare, whereas postoperative pleural drainage remains the dominant morbidity. Elevated pulmonary artery pressure seems to be a marker of unfavorable outcome. Continued investigation is warranted to determine whether medical interventions or alterations to operative strategy can alter peri-operative results and improve long-term outcomes.

Original languageEnglish
Pages (from-to)1018-1025
Number of pages8
JournalJournal of the American College of Cardiology
Issue number11
StatePublished - Sep 11 2012


  • Fontan procedure
  • cardiopulmonary bypass
  • congenital heart defects
  • single ventricle


Dive into the research topics of '18 years of the Fontan operation at a single institution: Results from 771 consecutive patients'. Together they form a unique fingerprint.

Cite this