Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay
Authors' conclusion
There is wide center variability in use of Fontan fenestration that is not explained by preoperative hemodynamics. Fenestration is independently associated with shorter LOS, and those with mPAP ≥13 mm Hg at pre-Fontan catheterization benefit the most.
Study context
- Population
- Patients aged 2 to 6 years at Fontan surgery, 2010–2020, with catheterization <1 year prior (Pediatric Heart Network dataset)
- Participants
- 702 patients
- Exposure
- Fontan fenestration vs no fenestration
- Fenestrationn = 465
- Outcome
- Factors associated with fenestration use and impact of fenestration on post-Fontan LOS
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Post-Fontan hospital LOS
- Fenestration associated with shorter hospital length of stay (LOS) after Fontan (multivariable linear model)
- P = 0.0024
- Fenestration use associated with center (range 27%-93% use)
- P < 0.0001
- Fenestration use associated with Fontan type: lateral tunnel vs extracardiac conduit, OR 14.1
- P < 0.0001
Observational data: associations, not effects.
Further findings
Post-Fontan hospital LOS, preoperative mean pulmonary artery pressure (mPAP) ≥13 mm Hg (subgroup)
- Benefit of fenestration on LOS most pronounced at mPAP ≥13 mm Hg: median LOS 9 vs 12 days
- P = 0.001
Factors associated with use of fenestration
- Fenestration used in 465 of 702 patients
- 66.2%
- Associated with center (range 27%-93% use)
- P < 0.0001
- Associated with Fontan type: OR 14.1 for lateral tunnel vs extracardiac conduit
- P < 0.0001
- No hemodynamic variable independently associated with fenestration
Original publication
Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay. JACC Adv. Published 5 February 2024. doi:10.
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