Improving results of the modified Fontan operation in patients with heterotaxy syndrome Christof Stamm, MD, Ingeborg Friehs, MD, Lennart F Duebener, MD,

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Presentation transcript:

Improving results of the modified Fontan operation in patients with heterotaxy syndrome Christof Stamm, MD, Ingeborg Friehs, MD, Lennart F Duebener, MD, David Zurakowski, PhD, John E Mayer, MD, Richard A Jonas, MD, Pedro J del Nido, MD The Annals of Thoracic Surgery Volume 74, Issue 6, Pages 1967-1978 (December 2002) DOI: 10.1016/S0003-4975(02)04124-3

Fig 1 (A) Kaplan-Meier estimated survival of patients with heterotaxy syndrome after a modified Fontan procedure. The solid markers indicate survival for patients who underwent the Fontan procedure since 1991; the open markers indicate patients operated on before 1991.Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses(since 1991,upper row; before 1991,lower row). The survival curves are significantly different (p= 0.005; log-rank test). (B) Kaplan-Meier estimated survival of patients with heterotaxy syndrome following a modified Fontan procedure. The solid markers indicate survival for patients with left atrial isomerism; the open markers indicate patients with right atrial isomerism.Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses(left isomerism, upper row; right isomerism, lower row) (p= 0.25; log-rank test). The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)

Fig 2 Kaplan-Meier estimated survival of patients with heterotaxy syndrome after a modified Fontan procedure. The open markers indicate survival for patients with anomalous pulmonary venous connection (APVC); the solid markersindicate patients with normal pulmonary venous connection. Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses (no APVC, upper row; with APVC, lower row). The survival curves are significantly different (p= 0.017; log-rank test). The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)

Fig 3 Kaplan-Meier estimated survival of patients with heterotaxy syndrome after a modified Fontan procedure. The open markers indicate survival for patients who had preoperative atrioventricular valve regurgitation (AVVR); the solid markers indicate patients without AVVR. Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses(no AVVR, upper row; with AVVR, lower row). The survival curves are not significantly different (p = 0.53; log-rank test). The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)

Fig 4 Kaplan-Meier estimated survival of patients with heterotaxy syndrome after a modified Fontan procedure according to the type of Fontan modification. Atriopulmonary= atriopulmonary anastomosis with atrial septation; intra-atrial tunnel = total cavopulmonary connection (TCPC) with lateral tunnel modification; tubular conduit = TCPC with intra-atrial, extracardiac, or intra-extracardiac tube graft. Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses(tubular conduit, upper row; intra-atrial tunnel, middle row; atriopulmonary, lower row). The survival curves are not significantly different (all p> 0.1; log-rank tests). The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)

Fig 5 Kaplan-Meier estimated freedom from late postoperative bradyarrhythmia of patients with heterotaxy syndrome after a modified Fontan procedure. This includes all forms of permanent or recurrent bradyarrhythmia, but excludes brief transient intraoperative or early postoperative bradyarrhythmia. The solid markers indicate survival for patients with left atrial isomerism; the open markers indicate patients with right atrial isomerism. Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses(left isomerism, upper row; right isomerism, lower row). (p= 0.019; log-rank test) The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)

Fig 6 Kaplan-Meier estimated freedom from late postoperative tachyarrhythmia of patients with heterotaxy syndrome after a modified Fontan procedure. This includes all forms of permanent or recurrent tachyarrhythmia, but excludes brief transient intraoperative or early postoperative tachyarrhythmia. The solid markers indicate survival for patients with left atrial isomerism; the open markers indicate patients with right atrial isomerism. Vertical bars indicate the lower 95% confidence intervals. The numbers of patients at risk are shown in parentheses (left isomerism, upper row; right isomerism, lower row). (p= 0.2; log-rank test). The Annals of Thoracic Surgery 2002 74, 1967-1978DOI: (10.1016/S0003-4975(02)04124-3)