Jess L. Thompson

The Fontan Operation: Is Timing Everything?

Since the introduction of the Fontan operation over 4 decades ago, surgical and medical management strategies have evolved to improve outcomes and give hope to the patients with complex single ventricle anomalies. Unfortunately, along with these new treatment successes, another group of problems has become more evident stimulating us to rethink our current management with a new focus on long-term outcomes and quality of life. The primary detrimental physiologic conditions that Fontan operation imposes on the patient are central venous hypertension and reduced cardiac output. 1 Hepatic dysfunction and protein losing enteropathy are felt to be related to the Fontan circulation with evidence that they may be a timedependent phenomena related to the time of Fontan operation. 2 In addition, the ventricle is abnormal with evidence of diastolic dysfunction becoming apparent in most. 3 With these sequelae in mind, there exists a controversy as to the best timing for completion Fontan. Some have adopted the belief that patients with total cavopulmonary connection have a limited amount of time before these issues become evident. Followers of the “ticking clock” theory would argue for delaying the Fontan operation until later in life in the hopes of postponing the long-term complications. Others argue that it may not only be time-dependent, and that performing an early Fontan operation may result in a better long-term single ventricle patient. Forsdick et al 4 present the outcomes of 45 patients who underwent a Fontan operation from 1976-2006. The average age of the patient at time of Fontan was 18-year old. Importantly, this cohort of patients represents all the adolescent and adult patients who underwent total cavopulmonary configuration in Australia or New Zealand. Data were available for 87% of the patients with a mean follow-up time of 15.5 years. They reported an early mortality of 6% and late mortality of 18%. Although these numbers are not significantly different than other reported series of adult Fontan patients, 5 they appear to be strikingly different than what has been reported by the same group for Fontan completion in a younger population. 6 They conclude that the results of performing a Fontan

The “right” way to repair recoarctation after the Norwood operation

From the Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Okla. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication Aug 8, 2016; accepted for publication Aug 8, 2016. Address for reprints: Harold M. Burkhart, MD, Division of Cardiovascular and Thoracic Surgery, University of Oklahoma Health Sciences Center, PO Box 26901, WP-2230, Oklahoma City, OK 73105 (E-mail: Harold-burkhart@ouhsc.edu). J Thorac Cardiovasc Surg 2016;-:1-2 0022-5223/

The Ross operation: Are we doing enough?

36.00 Copyright 2016 by The American Association for Thoracic Surgery http://dx.doi.org/10.1016/j.jtcvs.2016.08.009