Objective:

To evaluate peri-Fontan factors associated with long-term adverse outcomes, including death, VAD implantation, and heart transplantation, in a contemporary single-center Fontan cohort.

Approach:

• Study Design: Retrospective, matched case-control study at a single congenital heart center.
• Population: Patients who underwent Fontan completion between January 1, 2000, and December 31, 2023, with cases defined as those reaching endpoints of all-cause mortality, VAD implantation, or heart transplantation.
• Matching: Two or three control subjects matched by year of Fontan surgery and time from Fontan to failure.
• Data Collection: Collected demographics and clinical data from electronic health records, including preoperative and perioperative variables.
• Statistical Analysis: Used univariate and multivariable conditional logistic regressions to analyze associations with poor outcomes.

Key Findings:

• Contemporary studies suggest that up to 25% of Fontan patients may experience significant complications or require transplantation within 20 years postoperatively.
• Identified predictors of adverse outcomes include dominant ventricular morphology, AV valve regurgitation, elevated pulmonary artery pressures, and perioperative complications.

Interpretation:

The transition from compensated Fontan physiology to overt failure is complex and multifactorial, with individual presentations varying in severity.

Limitations:

• Heterogeneity in patient populations, duration of follow-up, and outcome definitions in existing literature.
• Exclusion of patients with incomplete medical records or perioperative FCF.

Conclusion:

The study highlights the need for early and reliable risk stratification in Fontan patients.