Characteristics Associated with Poor Long-Term Outcomes in Patients with Fontan Palliation: A Case-Control Study
By
Anusha Konduri
Sunkyung Yu
Scott Breshears
Ashley Duimstra
Timothy Lancaster
Vikram Sood
Jennifer Romano
Amanda D. McCormick
Heang M. Lim
David M. Peng
Kurt R. Schumacher
June 26, 2026
Clinical Scorecard: Factors Linked to Adverse Long-Term Outcomes in Patients Undergoing Fontan Palliation: A Case-Control Analysis
At a Glance
Category Detail
Condition Fontan circulation and associated complications Key Mechanisms Chronic hemodynamic stress, elevated central venous pressure, reduced preload, diminished cardiac output, chronic venous congestion, progressive end-organ dysfunction Target Population Children with single-ventricle physiology undergoing Fontan procedure Care Setting Congenital heart center
Key Highlights
Up to 25% of Fontan patients may experience significant complications or require transplantation within 20 years postoperatively Fontan circulatory failure (FCF) is a leading cause of long-term morbidity and mortality Adverse outcomes include all-cause mortality, VAD implantation, and heart transplantation Potential predictors of adverse outcomes include dominant ventricular morphology and AV valve regurgitation The transition from compensated Fontan physiology to overt failure is often insidious and multifactorial Guideline-Based Recommendations
Diagnosis
Evaluate preoperative and perioperative variables including age, cardiac anatomy, and hemodynamic data Management
Consider heart transplantation as definitive therapy for end-stage Fontan failure Monitoring & Follow-up
Regular assessment of cardiac function and hemodynamics post-Fontan completion Risks
Monitor for complications such as elevated pulmonary artery pressures and AV valve regurgitation Patient & Prescribing Data
Patients who underwent Fontan completion at a single congenital heart center
Long-term outcomes are influenced by perioperative factors and individual patient characteristics
Clinical Best Practices
Implement early risk stratification for Fontan patients Utilize a matched case-control design for evaluating outcomes Collect comprehensive longitudinal clinical data for analysis Related Resources & Content
