Is It Time to Revive the Lateral Tunnel Fontan? An STS Database Analysis of Early Outcomes

E. Kisamori¹, R. Mehta², A. Kaminski³, A. Venna⁴, C. Yerebakan⁵, M. Desai⁶, A. Tongut⁷, Y. d'Udekem^8
1Childrens National Hospital, Washington, District of Columbia ²Division of Cardiac Surgery, Children's National Hospital, Washington, D.C., USA., Washignton, District of Columbia ³Children's National Hospital, Washington, District of Columbia ⁴Children's National Hospital, Washignton, District of Columbia ⁵Children’s National Medical Center, Washington, District of Columbia ⁶Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA., Washington, District of Columbia ⁷Children’s National Hospital, Washington DC, District of Columbia ⁸Division of Cardiac Surgery, Children's National Hospital, Washington, D.C., USA., Washington, District of Columbia

Purpose: We intended to identify whether the lateral tunnel (LT) and extra-cardiac conduit (ECC) Fontan provide similar short-term outcomes in contemporary data. We hypothesized that LT would achieve better short-term outcomes in patients with smaller weight, younger age and heterotaxia.

Methods: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database who underwent a primary LT or ECC from 2012 to 2022 were included. There were 11,429 Fontan procedures performed in 133 centers: 2,012 LT (17.6%) and 9,417 ECC (82.4%).

Results: Only 2.7%surgeons (9) were exclusively performing LT while 57.4% (190) surgeons were exclusively performing ECC and 39.9% (132) were using both techniques. Similarly, only 0.8% hospitals (1) performed exclusively LT while 37.6% (50) performed ECC and 61.7% (82) used both techniques. At the time of surgery, patients undergoing the LT had a younger age (2.7 years (IQR 2.1-3.4) vs 3.6 (3-4.5); p< 0.001) and a smaller weight (13kgs (11.1, 14.7) vs 14.7 (13- 16.3); p< 0.001). The operative mortality (1.1% for LT vs 1.3% for ECC; p= 0.49) was similar (Table). Patients undergoing ECC had higher rate of 30-day readmission 1445 (18%) vs 220 (13.9%), p< 0.001), prolonged length of stay (>30days) (583 (6.2%) vs 78 (3.9%), p< 0.001), pleural effusion requiring drainage (1147 (17.3%) vs 140 (13.3%), p< 0.001), chylothorax (864 (13.1%) vs 98 (9.3%), p< 0.001), and stroke (117 (1.8%) vs 9 (0.9%), p=0.03). In patients with smaller body weight, the mortality rate was nearly twice as high in the LT group compared to the ECC group (2.1% (40) vs 1.2% (12) (p=0.1). In patients with younger age or those with heterotaxia, no differences in mortality were noted.

Conclusion: Despite being done in smaller and younger patients, LT is associated with similar mortality, lower 30-day readmission rate, lower prolonged hospital stay rate, lower rate of pleural effusion.

Identify the source of the funding for this research project: Internal