Analysis of perioperative factors in the development of early Fontan failure : a single-center experience

Aim Early Fontan failure (EFF) after Fontan surgery is rarely observed. Examining perioperative factors associated with this complication, which can lead to mortality and morbidity , is crucial for early diagnosis and treatment. Material and Methods All pediatric patients who underwent Fontan surgery between 2019 and 2023 were retrospectively analyzed. Preoperative demographic, echocardiographic, and angiographic data were collected. Hospital data related to operative and postoperative variables were retrospectively examined. The relationship between these variables and the development of EFF was investigated. Results A total of 21 Fontan patients were included in this study, and 10 of them (47.6%) developed EFF. Postoperatively, three patients (14.2%) died. Of the patients, 52.4% were male, with a median age of 4.5 years. Among the findings, postoperative maximum vasoactive-inotropic score (maxVIS) within the first 24 postoperative hour (p=0.023) and initial blood gas lactate values (p=0,019) were significantly higher in patient who developed EFF. Furthermore, the need for renal replacement therapy (p=0.020) and extracorporeal membrane oxygenation (ECMO) (p=0.020) were found to be associated with EFF. Delay in extubation due to hemodynamic instability has been identified as a significant risk factor for the development of EFF. Conclusion The postoperative maxVIS value in postoperative 24 hour and initial lactate levels in intensive care unit were found to be associated with EFF development. Delay in extubation due to hemodynamic instability has been identified as a significant risk factor for the development of EFF.