Ventricular Morphology and Outcomes in Fontan Circulation without Hypoplastic Left Heart Syndrome: A Single-Center's Experience.

BACKGROUND

The impact of dominant ventricular morphology on Fontan patient outcomes remain controversial. This study evaluates long-term results of right ventricle (RV) dominance versus left ventricle (LV) dominance in Fontan circulation without hypoplastic left heart syndrome (HLHS).

METHODS

We retrospectively examined 323 Fontan operations from our center. To minimize pre- and intra-Fontan heterogeneity, 42 dominant RV patients were matched with 42 dominant LV patients using propensity score matching, allowing for a comparative analysis of outcomes between groups.

RESULTS

The mean follow-up was 8.0 4.6 years for matched RV dominant and 6.5 4.7 years for matched LV dominant group ( 0.05), showing no significant difference. The cumulative incidence of moderate or greater atrioventricular valve regurgitation was also comparable between the two groups ( 0.05). Similarly, 10-year freedom from death or transplantation following the Fontan operation was 84% 7% in the matched dominant RV group, similar to 81% 7% in the matched dominant LV group ( 0.05). The 10-year freedom from Fontan failure was 78% 8% in the matched dominant RV group, also similar to 75% 8% in the matched dominant LV group ( 0.05). Multivariate analysis did not identify RV dominance as a risk factor for Fontan failure ( 0.05).

CONCLUSIONS

In the pre- and intra-Fontan context, RV dominance demonstrated similar and comparable long-term outcomes compared to LV dominance in non-HLHS Fontan circulation.