TY - JOUR
T1 - Early outcomes of children with univentricular circulation undergoing Fontan surgery
T2 - the EuroFontan registry
AU - Padalino, Massimo A
AU - Constantine, Andrew
AU - Bergonzoni, Emma
AU - Cao, Irene
AU - Horer, Jurgen
AU - Ono, Masamichi
AU - Staehler, Helena
AU - Sames-Dolzer, Eva
AU - Gierlinger, Gregor
AU - Hazekamp, Mark
AU - Rijnberg, Friso M
AU - Galletti, Lorenzo
AU - Butera, Gianfranco
AU - Panebianco, Mario
AU - Meyns, Bart
AU - Van Puyvelde, Joeri
AU - Yemets, Illya
AU - Bairamov, Elshad
AU - Kansy, Andrzej
AU - Nosal, Matej
AU - Lenoir, Marien
AU - Angeli, Emanuela
AU - Careddu, Lucio
AU - Martens, Thomas
AU - Bove, Thierry
AU - Napoleone, Carlo Pace
AU - Lo Rito, Mauro
AU - Giamberti, Alessandro
AU - Montanaro, Claudia
AU - Marianeschi, Stefano
AU - Agati, Salvatore
AU - Sarris, George K
AU - Protopapas, Eleftherios
AU - Rocafort, Alvaro Gonzalez
AU - Scrascia, Giuseppe
AU - Meliota, Giovanni
AU - Vairo, Ugo
AU - Michielon, Guido
AU - Gozzi, Anna
AU - Biffanti, Roberta
AU - Castaldi, Biagio
AU - Gregori, Dario
AU - Vedovelli, Luca
AU - Di Salvo, Giovanni
AU - Vida, Vladimiro
AU - Dimopoulos, Konstantinos
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2025/10/23
Y1 - 2025/10/23
N2 - BACKGROUND AND AIMS: The Fontan operation and its modifications have transformed the management of children with functional single ventricle physiology. While outcomes have improved, peri-operative complications remain common. This study aimed to assess early outcomes and complications following Fontan completion in a large international European cohort.METHODS: The EuroFontan registry is a multicentre retrospective study involving 21 congenital heart disease and transplant centres across Europe. Data were collected on patients who underwent Fontan surgery from January 1990 to January 2023. Analyses focused on the most recent 15-year period. A composite early adverse outcome (death within 30 days or in-hospital, low cardiac output syndrome, stroke, or Fontan takedown) was used. Predictors were assessed using multivariable mixed-effects logistic regression, with centre included as a random effect. Missing data were handled using multiple imputation with Rubin's rules, and sensitivity analyses were performed to assess robustness.RESULTS: Of 3510 patients, this analysis focused on 2075 individuals from the past 15 years, with a median age of 4.2 [interquartile range 3.2-6.2] years at Fontan completion. Early mortality was 1.0% (95% confidence interval .66%-1.54%). The composite adverse outcome occurred in 5.1% (95% confidence interval 4.2%-6.1%). On multivariable analysis, morphology other than tricuspid atresia was the only significant predictor of the composite outcome (odds ratio 2.2, 95% confidence interval 1.21-3.99, P = .01).CONCLUSIONS: Fontan surgery has evolved and, in contemporary practice, has low peri-operative morbidity and mortality. Morphology other than tricuspid atresia was associated with increased risk of early adverse outcomes, highlighting the importance of pre-operative risk stratification.
AB - BACKGROUND AND AIMS: The Fontan operation and its modifications have transformed the management of children with functional single ventricle physiology. While outcomes have improved, peri-operative complications remain common. This study aimed to assess early outcomes and complications following Fontan completion in a large international European cohort.METHODS: The EuroFontan registry is a multicentre retrospective study involving 21 congenital heart disease and transplant centres across Europe. Data were collected on patients who underwent Fontan surgery from January 1990 to January 2023. Analyses focused on the most recent 15-year period. A composite early adverse outcome (death within 30 days or in-hospital, low cardiac output syndrome, stroke, or Fontan takedown) was used. Predictors were assessed using multivariable mixed-effects logistic regression, with centre included as a random effect. Missing data were handled using multiple imputation with Rubin's rules, and sensitivity analyses were performed to assess robustness.RESULTS: Of 3510 patients, this analysis focused on 2075 individuals from the past 15 years, with a median age of 4.2 [interquartile range 3.2-6.2] years at Fontan completion. Early mortality was 1.0% (95% confidence interval .66%-1.54%). The composite adverse outcome occurred in 5.1% (95% confidence interval 4.2%-6.1%). On multivariable analysis, morphology other than tricuspid atresia was the only significant predictor of the composite outcome (odds ratio 2.2, 95% confidence interval 1.21-3.99, P = .01).CONCLUSIONS: Fontan surgery has evolved and, in contemporary practice, has low peri-operative morbidity and mortality. Morphology other than tricuspid atresia was associated with increased risk of early adverse outcomes, highlighting the importance of pre-operative risk stratification.
U2 - 10.1093/eurheartj/ehaf835
DO - 10.1093/eurheartj/ehaf835
M3 - Article
C2 - 41127893
SN - 1522-9645
JO - European Heart Journal
JF - European Heart Journal
M1 - ehaf835
ER -