A Thesis submitted for sub special degree in pediatric heart disease Evaluation of early and mid-term outcomes of Fontan surgery in children with congenital heart disease

Abstract

Fontan surgery is a palliative operation for patients with anatomical or functional single ventricle. Although few studies have been performed on patients undergoing fontan surgery, this study attempted to provide a relative evaluation of patients undergoing fontan surgery and their clinical outcomes. Materials and Methods: This descriptive study was performed on all patients who underwent fontan surgery in Shahid Madani Hospital in Tabriz from 2006 to 2016 due to congenital heart disease. All demographic information, preoperative echocardiographic findings, angiographic findings, previous palliative heart surgery, type and technique of surgery performed, as well as postoperative complications of fontan, need for postoperative fontan surgery and cause of death immediately after surgery, Was extracted from the patients' files and the delayed complications after the next followed up operation were investigated and determined by communicating with the patient's family. Results: In this study, 52 patients were included in the study. A review of the records revealed that 8 patients died during hospitalization or immediately after surgery and 44 patients were discharged (in-hospital mortality rate was 15.3%). Out of 44 patients, 11 patients were out of reach due to change of address or lack of cooperation and 33 patients were followed up (for a median of 7 years (1 to 13 years)). During the examination and contact with the patients' families, it was found that out of 33 patients: 8 patients died and 25 patients (75.8% of the 33 patients) were invited for examination. [A total of 16 patients (30.7%) out of a total of 52 patients had died within 10 years. 10 patients died due to heart and respiratory failure (62.5%), 3 patients due to arrhythmia (18.75%) and 3 patients due to bleeding and the possibility of thrombosis (18.75%)]. The median follow-up of patients was 7 years (range 1 to 13 years). The mean age at surgery was 7.01 ± 5.13 years. 29 patients (55%) were male and 23 patients (45%) were female. The mean weight of patients was 18.00 ± 10.64 kg. The main cause of fontan surgery in more than half of patients with Tricuspid Atresia was 8.53%. The mean oxygen saturation of SO2sat in patients was 78.18 ± 8.75 and the mean mean blood pressure (PAP) was 14.10 ± 76.91. The diastolic end pressure of the ventricle was 28.4 ± 27.10. As primary palliative surgery, Bidirectional Glenn surgery was performed on 30 patients (6.57%) The highest frequency among fontan surgeries was Conduit Extracardiac (6.61%) Fenestration was performed on all patients except 15 patients. Complications were related to prolonged pleural effusion and neurological [10 patients (2.19% each)], and 9 patients required reoperation. Differences in preoperative PAP levels, differences in the type of fontan surgery before surgery, and differences in the type of fontan surgery technique, a significant relationship with mortality rate and ventricular systolic and diastolic function during long-term follow-up and the rate of complications immediately after they had no action.