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Eur J Cardiothorac Surg 2005;27:250-257
© 2005 Elsevier Science NL

Fontan conversion with arrhythmia surgery

^a Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu Seoul 110-799, Korea
^b Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu Seoul 110-799, Korea

Received 20 August 2004; received in revised form 5 October 2004; accepted 18 October 2004.

^* Corresponding author. Tel.: +82 2 760 2340; fax: +82 2 760 3566. (E-mail: kyj{at}plaza.snu.ac.kr).

Objective: Hemodynamic abnormalities and refractory atrial arrhythmias in patients late after the Fontan operation result in significant morbidity and mortality. We reviewed our experience with Fontan conversion and concomitant arrythmia surgery. Methods: Between January 1996 and February 2004, 16 patients underwent Fontan conversion and arrhythmia surgery. Mean age at the initial Fontan operation was 5.1±3.5 (range: 2–15) years and mean age at Fontan conversion was 17.0±5.8 (range: 6–30). The initial Fontan operations were atriopulmonary connections in 14 patients, extracardiac lateral tunnel in 1, and intracardiac lateral tunnel in 1. The types of arrhythmia included atrial flutter in 10 patients and atrial fibrillation in 3. Fontan conversion operation was performed with intracardiac lateral tunnel in 5 patients and extracardiac conduit in 11. Arrhythmia surgery included isthmus cryoablation in 10 patients and right-sided maze in 3. Results: There has been no mortality. At Fontan conversion operation, 7 patients required permanent pacemaker. All patients have improved to New York Heart Association class I or II. With a mean follow-up of 26.9±30.6 (range:1–87) months, 16 patients had sinus rhythm, 2 patients had transient atrial flutter which was well controlled, and 2 patients required permanent pacemaker during follow-up. Conclusions: Fontan conversion with concomitant arrhythmia surgery and permanent pacemaker placement is safe, improves New York Heart Association functional class, and has a low incidence of recurrent arrhythmias. In most patients, concomitant permanent pacemakers are needed.

Key Words: Fontan conversion • Arrhythmia surgery

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