Long term outcomes following Fontan takedown in Australia and New Zealand

Abstract Objective Fontan takedown remains an option for the management of Fontan failure. We sought to evaluate early and late outcomes after Fontan takedown. Methods The Australia and New Zealand Fontan Registry was interrogated to identify all patients who had a Fontan takedown. Results Over a 43-year study period (1975-2018), 36 of 1540 (2.3%) had a Fontan takedown. The median age at takedown was 5.1 years (IQR=3.7, 7.0). Nine (25%) patients had a takedown within 48 hours, 6 (16%) between 2 days-3 weeks, 14 (39%) between 3 weeks-6 months while 7 (19%) had a late takedown (>6 months). Median interval to takedown was 26 days (IQR=1.8, 11.3). Sixteen (44%) patients died at a median of 57.5 days (IQR 21.8, 76.8). The highest mortality occurred between 3 weeks-6 months ( 6 months: 2/7, 28%; p=0.007). At median follow-up of 9.4 years (IQR 4.5, 15.3), 11 (31%) patients were alive with an intermediate circulation (10 in NYHA I/II). Five (14%) patients underwent a successful second Fontan. Freedom from death/transplant after Fontan takedown was 59% 56% and 52% at 1,5 and 10 years respectively. Conclusions The incidence of Fontan takedown is low, but mortality is high. The majority of takedowns occurred within 6 months. Mortality was lowest when takedown occurred