Fontan Surgery Instead of Biventricular Repair in Complex Cardiac Anomalies: A Good Alternative

Background: The Fontan operation has improved the survival of children born with congenital heart disease with single ventricle physiology. The most widely adopted variations of the Fontan procedure are the extracardiac conduit (ECC), the lateral tunnel (LT) ve the intra/extracardiac conduit with fenestration. Despite advances in the treatment and prevention of early and late complications that may develop after Fontan surgery, morbidity still remains an important problem. Methods 304 patients who underwent Fontan surgery in our center between 1995–2022 were included in our study. The complications that developed in patients who underwent primary Fontan or lateral tunnel surgery and extracardiac conduit Fontan application were compared. Results Classic Fontan surgery and lateral tunnel surgery were performed in 26 of the patients, and extracardiac Fontan surgery was performed in 278 patients. 218 of 304 cases were patients with single ventricular pathology. 86 cases were patients with two ventricular morphologies but complex cardiac pathology. When complications between Fontan procedures were compared in our study, prolonged pleural effusion was found more frequently in patients with extracardiac disease after Fontan surgery. Conclusion There are unresolved questions regarding the choice of Fontan procedures and their impact on complication development. Palliative surgical operations aimed at the preparation of the fontan circulation lead to the preparation of the pulmonary vascular bed and the preservation of ventricular function. Early and long-term complications in Fontan surgery affect the survival of patients. In our study, we wanted to contribute to the literature by presenting our 27 years of experience in Fontan surgery.