A 10-Year Single Center Report on Fontan Attrition and Non-Fontan Candidacy

Abstract Background: As patients progress through single ventricle (SV) palliation, changing hemodynamics and patient conditions can prevent progression to Fontan. We sought to determine the incidence of Fontan completion at our institution and to investigate the reasons for non-Fontan candidacy. Methods: Patients who underwent superior cavopulmonary anastomosis (SCPA) from 2010 to 2020 at a single institution were included. Pre-Fontan testing was reviewed for all patients and primary reason for non-candidacy was determined based on review of the electronic medical records. Results: Of 427 patients included, 396 (93%) underwent Fontan or were referred for Fontan at the time of the study. Reasons for non-Fontan candidacy in the remaining 31 patients included cardiac reasons (n = 26), mainly univentricular dysfunction or atrioventricular valve (AVV) regurgitation, respiratory conditions (n = 3), or miscellaneous reasons (n = 2). The patients who were non-Fontan candidates due to respiratory conditions and miscellaneous reasons are all alive without further palliation at the time of the study. There are 17 patients (17/31; 55%) in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. Non-Fontan candidates had a higher incidence of moderate or severe AVV regurgitation prior to SCPA. There were no other significant differences in hemodynamics pre-SCPA between the Fontan and non-Fontan candidates. Discussion: Thirty-one patients (31/427; 7%) were not Fontan candidates at our center. Our results demonstrate that the reasons for non-Fontan candidacy after completion of SCPA are broadly due to hemodynamic and respiratory concerns. Predicting non-Fontan candidacy at the time of SCPA is difficult based on echocardiographic and hemodynamic catheterization data.