Biventricular conversion after Fontan completion: A preliminary experience

Abstract Objective To assess the feasibility and outcomes of biventricular conversion following takedown of Fontan circulation. Methods Retrospective analysis of patients who had takedown of Fontan circulation and conversion to biventricular circulation at a single center from September 2007 to April 2020. Failing Fontan physiology was defined as Fontan circulation pressure >15 mmHg and/or presence of associated complications. Results Biventricular conversion was performed in 23 patients at a median age of 10.0 (7.5-13.0) years. Indications included failing Fontan physiology in 15 (65%) and elective takedown in 8 (35%) patients. A subset of patients (n=6) underwent procedures for staged recruitment of the non-dominant ventricle prior to conversion. Median z score of end diastolic volume of borderline ventricle prior to take down was -2.3 (-3.3, -1.3). Hypoplastic left heart syndrome (P Conclusions A primary as well as a staged biventricular conversion is feasible in patients who have had previous Fontan procedure. Although this provides an alternative to transplantation in patients with failing Fontan, outcomes are worse in those with failing Fontan compared to elective takedown of Fontan circulation. Optimal timing needs further evaluation.