Surgical reinterventions after modified Fontan operations.

Abstract

Surgical reinterventions after Fontan operations are still associated with high mortality. This investigation aims to summarize our experience with such repeated operations and to assess their efficacy. In 1983 through 1995 we performed 162 different modifications of Fontan operation. Repeated interventions were needed in 15 cases (9%). An analysis of all these cases is presented. Repeated operation consisted of the closure of residual interatrial communication (3 patients), atrioseptostomy (4), subaortic stenosis resection (1), pulmonary balloon valvuloplasty (1), embolization of residual right ventricular-pulmonary arterial communication (1), pericardectomy (2), pleurectomy (1), pacemaker implantation (1), and takedown of the Fontan operation (1). The results of operation were judged as good in 6 cases (40%) and as satisfactory in 5 (33%); 4 patients (27%) died. Repeated interventions aimed at the elimination of technical errors of the Fontan operation are successful in most cases. Atrial septostomy gives good results in the absence of anatomic causes of cardiac failure such as subaortic obstruction and atrioventricular valve insufficiency.