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Background <p>The Fontan procedure is the final common pathway of single ventricle palliation. Over the years, there has been much evolution in the technique of the Fontan procedure and the so-called Ten Commandments to guide the selection of a classic patient for successful Fontan completion. We present our experience of operating on patients with &gt; 15&#xa0;mm Hg preoperative mean pulmonary artery pressure (mPAP).</p> Methods <p>A retrospective analysis was carried out to identify patients with a mPAP &gt; 15&#xa0;mm Hg who underwent Fontan completion between January 2014 and December 2024 in our institute.</p> Results <p>A total of 159 patients underwent Fontan surgery during this time period. Of them, 18 (11.3%) patients had a mPAP &gt; 15&#xa0;mm Hg; 13 (72.2%) had mPAP 16–18&#xa0;mm Hg, and 5 (27.8%) had mPAP &gt; 18&#xa0;mm Hg. The median age at Fontan surgery was 14.9&#xa0;years. Mean duration of postoperative intensive care unit (ICU) stay was 2 (± 0.8) days, and mean duration of hospital stay was 10 (± 3.1) days. Pulmonary vasodilators were used to treat 5 (27.8%) patients before the completion of Fontan; all 18 patients had postoperative pulmonary vasodilator therapy continued for 6–12&#xa0;weeks. One patient expired (mortality 5.6%) due to postoperative overwhelming sepsis. There was no readmission. The mean duration of follow-up was 4.1&#xa0;years.</p> Conclusion <p>Carefully selected patients with elevated preoperative mPAP and acceptable Pulmonary Vascular Resistance Index (PVRI) can undergo Fontan completion with satisfactory early and medium-term outcomes.</p>

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Breaking the commandments: feasibility and medium-term outcome of Fontan procedure in patients with high preoperative mean pulmonary artery pressure

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Deepali Bangalia,
  • Rajarshi Ghosh,
  • Somrita Laha,
  • Joshi Siddhartha,
  • Hemanta Kumar Nayak,
  • Srikant Sharma,
  • Rahul Bose,
  • Sudipta Bhattacharjya,
  • Arnab Paul,
  • Srirup Chatterjee,
  • Satyajit Bose

摘要

Background

The Fontan procedure is the final common pathway of single ventricle palliation. Over the years, there has been much evolution in the technique of the Fontan procedure and the so-called Ten Commandments to guide the selection of a classic patient for successful Fontan completion. We present our experience of operating on patients with > 15 mm Hg preoperative mean pulmonary artery pressure (mPAP).

Methods

A retrospective analysis was carried out to identify patients with a mPAP > 15 mm Hg who underwent Fontan completion between January 2014 and December 2024 in our institute.

Results

A total of 159 patients underwent Fontan surgery during this time period. Of them, 18 (11.3%) patients had a mPAP > 15 mm Hg; 13 (72.2%) had mPAP 16–18 mm Hg, and 5 (27.8%) had mPAP > 18 mm Hg. The median age at Fontan surgery was 14.9 years. Mean duration of postoperative intensive care unit (ICU) stay was 2 (± 0.8) days, and mean duration of hospital stay was 10 (± 3.1) days. Pulmonary vasodilators were used to treat 5 (27.8%) patients before the completion of Fontan; all 18 patients had postoperative pulmonary vasodilator therapy continued for 6–12 weeks. One patient expired (mortality 5.6%) due to postoperative overwhelming sepsis. There was no readmission. The mean duration of follow-up was 4.1 years.

Conclusion

Carefully selected patients with elevated preoperative mPAP and acceptable Pulmonary Vascular Resistance Index (PVRI) can undergo Fontan completion with satisfactory early and medium-term outcomes.