Comparison of outcomes following the Fontan procedure between patients with previous ductus stent and aortopulmonary shunt.

OBJECTIVES

In this study, we aimed to compare the outcome after the Fontan procedure in patients after an initial ductus stenting or a surgical aortopulmonary shunt.

METHODS

We reviewed infants with single ventricle and ductal-dependent pulmonary blood flow who underwent ductus stenting or an aortopulmonary shunt between 2009 and 2022, and subsequently underwent the staged Fontan procedure.

RESULTS

A total of 93 patients were included (39 ductus stenting and 54 aortopulmonary shunts). Before the Fontan procedure, pulmonary artery pressure (9 vs 9 mmHg, P = 0.376) and pulmonary artery index (184 vs 183 mm2/m2, P = 0.988) were similar between the groups. However, the incidence of venovenous collaterals was higher in patients after ductus stenting than those after aortopulmonary shunt (35.9 vs 16.7%, P = 0.034). Median age (1.9 vs 1.8 years, P = 0.493) and weight at the Fontan procedure (12 vs 11 kg, P = 0.596) were similar between the groups. There was no in-hospital mortality in each group. The length of the intensive care unit stay (median 5 vs 5 days, P = 0.542) and hospital stay (median 17 vs 14 days, P = 0.767) were similar between the groups. During the median follow-up of 2.5 years, one late death was observed in the ductal stenting group. Freedom from reintervention (66.6 vs 82.0%, P = 0.095) and from adverse events (78.6 vs 92.2%, P = 0.488) at 5 years were similar between the groups.

CONCLUSIONS

This pilot study demonstrated comparable outcomes following the Fontan procedures between patients with single ventricle and ductal-dependent pulmonary blood flow after initial ductus stenting and those after initial aortopulmonary shunt.