Extracardiac Versus Lateral Tunnel Fontan: A Meta-Analysis of Long-Term Results

Published on Mar 1, 2019in The Annals of Thoracic Surgery3.92
· DOI :10.1016/j.athoracsur.2018.08.041
Walid Ben Ali2
Estimated H-index: 2
(MHI: Montreal Heart Institute),
Ismail Bouhout9
Estimated H-index: 9
(MHI: Montreal Heart Institute)
+ 2 AuthorsNancy Poirier22
Estimated H-index: 22
(MHI: Montreal Heart Institute)
Background There is growing awareness of the long-term impact of a Fontan circulation on the associated morbidity and mortality. Comparative data on the incidence of supraventricular arrhythmia and sinus node dysfunction following extracardiac conduit (EC) and lateral tunnel (LT) Fontans are controversial. We performed a meta-analysis pooling all available long-term results comparing the EC and LT Fontan, with a special focus on arrhythmia. Methods We performed a systematic search of PubMed, Embase, and the Cochrane Library for articles reporting long-term results of Fontan comparing the EC and the LT Fontan. Results Twelve studies were selected with 3,330 patients (1,729 EC, 1,601 LT). Freedom from tachyarrhythmia was significantly higher in the EC group (92% versus 83% at 15 years; p p = 0.7). The survival was 93% and 89% at 20 years in the EC and LT groups, respectively ( p = 0.007). The risk of thromboembolic events was 2.87% patient-years in the EC group versus 0.9% in the LT group (odds ratio, 2.15; 95% confidence interval, 0.95 to 4.85; p = 0.07). Conclusions The EC Fontan confers long-term survival advantage over the LT Fontan without a higher rate of reoperations. The EC Fontan preserves the sinus node function and reduces significantly the incidence of long-term postoperative arrhythmia.
  • References (29)
  • Citations (1)
Published on Oct 15, 2015in Heart5.08
Quinton E1
Estimated H-index: 1
Nightingale P1
Estimated H-index: 1
+ 4 Authorsde Bono J1
Estimated H-index: 1
Objectives The Fontan procedure provides palliation for patients with complex congenital heart disease. A late complication is the development of a pro-arrhythmogenic environment. Modifications to the surgical technique try and reduce the incidence of late arrhythmia. This study aims to establish incidence and outcome of arrhythmias in Fontan patients with long-term follow-up. Methods Retrospective analysis of adult patients with a Fontan circulation cared for by University Hospitals Birmingham ...
Published on Jan 2, 2015in BMJ27.60
Larissa Shamseer23
Estimated H-index: 23
(Ottawa Hospital Research Institute),
David Moher126
Estimated H-index: 126
+ 5 AuthorsLesley Stewart45
Estimated H-index: 45
(Ebor: University of York)
Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is...
Published on Sep 9, 2014in Circulation23.05
Yves d’Udekem28
Estimated H-index: 28
Ajay J. Iyengar14
Estimated H-index: 14
+ 12 AuthorsGary F. Sholler23
Estimated H-index: 23
Background—The life expectancy of patients undergoing a Fontan procedure is unknown. Methods and Results—Follow-up of all 1006 survivors of the 1089 patients who underwent a Fontan procedure in Australia and New Zealand was obtained from a binational population-based registry including all pediatric and adult cardiac centers. There were 203 atriopulmonary connections (AP; 1975–1995), 271 lateral tunnels (1988–2006), and 532 extracardiac conduits (1997–2010). The proportion with hypoplastic left ...
Seshadri Balaji19
Estimated H-index: 19
(OHSU: Oregon Health & Science University),
Ankana Daga8
Estimated H-index: 8
(UPenn: University of Pennsylvania)
+ 14 AuthorsSabrina Tsao13
Estimated H-index: 13
(Children's Memorial Hospital)
Objective The study objective was to determine whether the extracardiac conduit Fontan confers an arrhythmia advantage over the intracardiac lateral tunnel Fontan. Methods This multicenter study of 1271 patients compared bradyarrhythmia (defined as need for pacing) and tachyarrhythmia (defined as needing antiarrhythmic therapy) between 602 patients undergoing the intracardiac Fontan and 669 patients undergoing the extracardiac Fontan. The median age at the time of the Fontan procedure was 2.1 ye...
Published on Feb 1, 2014in Acta Cardiologica0.95
Katrien De Vadder1
Estimated H-index: 1
(Katholieke Universiteit Leuven),
Alexander Van De Bruaene14
Estimated H-index: 14
(Katholieke Universiteit Leuven)
+ 3 AuthorsWerner Budts44
Estimated H-index: 44
(Katholieke Universiteit Leuven)
Background The Fontan procedure has become the procedure of choice for patients with one functional ventricle. Although perioperative mortality has decreased, late failure of the Fontan circulation remains a major concern. We aimed at (i) describing Fontan patient characteristics and (ii) identifying simple risk factors for outcome.Methods Seventy-three patients (median age 23 y (IQR 19-29 y), 60.3% male) were selected from the database of congenital heart defects. Followup data were collected. ...
Pranava Sinha9
Estimated H-index: 9
(Children's National Medical Center),
David Zurakowski98
Estimated H-index: 98
(Boston Children's Hospital)
+ 4 AuthorsRichard A. Jonas82
Estimated H-index: 82
(Children's National Medical Center)
Objective The study objective was to compare the incidence of short- and intermediate-term arrhythmias among 3 different surgical modifications of the Fontan procedure. Methods We performed a retrospective review of all patients who underwent the Fontan operation at a single institution between January 2004 and May 2010 for preoperative, perioperative, and follow-up variables. Three surgical modifications were studied: intra/extracardiac conduit with limited atriotomy, standard extracardiac cond...
Published on Dec 1, 2012in BMC Medical Research Methodology2.51
Patricia Guyot3
Estimated H-index: 3
(UoB: University of Bristol),
Ae Ades58
Estimated H-index: 58
(UoB: University of Bristol)
+ 1 AuthorsNicky J Welton43
Estimated H-index: 43
(UoB: University of Bristol)
Background The results of Randomized Controlled Trials (RCTs) on time-to-event outcomes that are usually reported are median time to events and Cox Hazard Ratio. These do not constitute the sufficient statistics required for meta-analysis or cost-effectiveness analysis, and their use in secondary analyses requires strong assumptions that may not have been adequately tested. In order to enhance the quality of secondary data analyses, we propose a method which derives from the published Kaplan Mei...
Published on Nov 20, 2012in Circulation23.05
Paul Khairy55
Estimated H-index: 55
(MHI: Montreal Heart Institute),
Nancy Poirier22
Estimated H-index: 22
(MHI: Montreal Heart Institute)
> “In theory, theory and practice are the same. In practice, they are not.” > > —Albert Einstein There is, perhaps, no disease entity that better exemplifies the complexities, challenges, and creative innovations characteristic of the evolution in congenital heart disease care than the univentricular heart. The univentricular heart encompasses an array of uncommon and severe inborn cardiac malformations that share a similar physiology, with pulmonary and systemic venous return predominantly dire...
Published on Oct 1, 2011in The Annals of Thoracic Surgery3.92
Hideo Ohuchi22
Estimated H-index: 22
Koji Kagisaki18
Estimated H-index: 18
+ 6 AuthorsToshikatsu Yagihara34
Estimated H-index: 34
Background Postoperative mortality has decreased in patients undergoing the Fontan operation, and the determinants of such mortality may also have changed significantly. Methods We conducted a study intended to focus on clarifying the determinants of mortality in 405 consecutive patients who had undergone a Fontan operation (62 patients after an atriopulmonary connection, 105 after an intra-atrial rerouting, and 238 patients after an extracardiac rerouting) between 1979 and 2010. Results The ove...
Cited By1
Published on Aug 1, 2019in Journal of the American College of Cardiology18.64
Catherine Deshaies1
Estimated H-index: 1
(UdeM: Université de Montréal),
Robert M. Hamilton40
Estimated H-index: 40
(U of T: University of Toronto)
+ 17 AuthorsAnnie Dore23
Estimated H-index: 23
(MHI: Montreal Heart Institute)
Abstract Background Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts. Objectives This study sought to evaluate the effect of type of Fontan surgery on thromboembolic risk. Methods A North American multicenter retrospective cohort study enrolled 522 patients with Fontan palliation consisting of an atriopulmonary connection (APC) (21.4%), lateral tunnel (LT) (41.8%), or extracardiac conduit (EC) (36.8%). Thromboembolic complicat...
Published on Jul 1, 2019in Canadian Journal of Cardiology5.59
Paul Khairy55
Estimated H-index: 55
(MHI: Montreal Heart Institute)
Abstract The expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between two subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebste...
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