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National Outcomes of the Fontan Operation with Endocardial Cushion Defect
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  • Sandeep Sainathan,
  • Sameh Said,
  • Chris Agala,
  • Leonardo Mulinari ,
  • Mahesh Sharma
Sandeep Sainathan
University of Miami Department of Surgery

Corresponding Author:[email protected]

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Sameh Said
University of Minnesota Division of Cardiothoracic Surgery
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Chris Agala
University of North Carolina at Chapel Hill Libraries
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Leonardo Mulinari
University of Miami Department of Surgery
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Mahesh Sharma
University of North Carolina at Chapel Hill Libraries
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Objective: The traditional outcomes of the Fontan Operation (FO) in Endocardial Cushion Defect (ECD) patients have been suboptimal. Previous studies have been limited by the smaller number of ECD patients, longer study period with an era effect and do not directly compare short-term outcomes of FO in ECD patients with non-ECD patients. Our study aims to address these shortcomings. Methods: A retrospective analysis of the Kids Inpatient Database (2009, 2012, and 2016) for the FO was done. The groups were divided into those who underwent FO with ECD as compared to non-ECD diagnosis. The data was abstracted for demographics, clinical characteristics, and operative outcomes. Standard statistical tests were used. Results: 3380 patients underwent the FO of which 360 patients (11%) were FO-ECD. ECD patients were more likely to have Down syndrome, Heterotaxy syndrome, transposition/DORV, and TAPVR as compared to non-ECD patients. FO-ECD had a higher discharge-mortality (2.84% vs. 0.45%, p=0.04). The length of stay (16 vs. 13 days, p=0.05) and total charges incurred ($ 283, 280 vs. 234, 106, p=0.03) for the admission were higher in the FO-ECD as compared to non-ECD patients. In multivariable analysis: ECD diagnosis, cardiac arrest, acute kidney injury, and post-operative hemorrhage were predictors of mortality. Conclusion: Contemporary outcomes for FO are excellent with very low overall operative mortality. However, the outcomes in ECD patients are inferior with higher operative mortality than non-ECD patients. Occurrence of post-operation complications, associated TAPVR and a diagnosis of ECD were predictive of a negative outcome.
17 Jan 2022Submitted to Journal of Cardiac Surgery
17 Jan 2022Submission Checks Completed
17 Jan 2022Assigned to Editor
27 Jan 2022Reviewer(s) Assigned
06 Mar 2022Review(s) Completed, Editorial Evaluation Pending
17 Mar 2022Editorial Decision: Revise Minor
18 Apr 20221st Revision Received
22 Apr 2022Submission Checks Completed
22 Apr 2022Assigned to Editor
28 Apr 2022Reviewer(s) Assigned
13 Jun 2022Review(s) Completed, Editorial Evaluation Pending
13 Jun 2022Editorial Decision: Accept
Oct 2022Published in Journal of Cardiac Surgery volume 37 issue 10 on pages 3151-3158. 10.1111/jocs.16742