Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone?

Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. 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How Far Have We Gone? Irene Cao, Emma Bergonzoni, Luca Vedovelli, Giulia Guerra, Lorenzo Galletti, and 27 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4283962/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Sep, 2024 Read the published version in Pediatric Cardiology → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Despite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities. Methods: This is a retrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database. Results: In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5 years (IQR 3.3 -6.4), median weight 16 kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4 years was associated with an early need for transcatheter reintervention (adj p-value=0.037) and a higher incidence of postoperative complications (adj p-value=0.017). Conclusion: The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4 years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients. single ventricle Fontan operative survival surgical palliation early outcomes univentricular heart Figures Figure 1 Introduction After the first repair for tricuspid atresia in Bordeaux in 1968 by Fontan and Baudet ( 1 ), surgical indications to the so-called Fontan palliation have progressively expanded to include various complex congenital heart diseases (CHD) with a functional single ventricle (FSV). Postoperative outcomes have shown a steady improvement over the years, and the high mortality rates experienced in the ’80s appear now to belong to the past ( 2 – 4 ). Nevertheless, despite these achievements, the postoperative management after Fontan remains challenging, particularly because of the usually prolonged recovery period and the consistent incidence of pleural effusions. Additionally, the optimal age for Fontan completion continues to be a topic of debate ( 5 ). We herein report our analysis in a large cohort of patients who underwent a Fontan completion in the last 3 decades, to assess current early results of Fontan operation and risk factors for early complications in a multicentric Italian study. Material and Methods Study design This is a multi-center retrospective observational study including patients with FSV undergoing Fontan completion between January 1990 and January 2023. This retrospective study was developed by the core institution (University of Padova, Italy). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in approval by each participating site’s ethical regulatory body. The overall study was approved by the Institutional Review Board at the University of Padova (nr. 20616, CESC code: 5423/AO/22) and by each participating center. The requirement for informed consent was waived given the study design. Clinical and surgical data were retrieved from medical records by local investigators and recorded in a secure online RedCap database between December 2021 and January 2023. Requested preoperative and postoperative data are described in detail in Tables 1 , 2 and 3 . Table 1 Groups including all cardiac diagnosis according to anatomical similarities and the presence of a significant additional chamber Group 1 Biventricular type 1 transposition of the great arteries, double outlet right and left ventricle, mitral atresia, criss cross heart, Ebstein anomaly. Group 2 Right ventricular hypoplasia tricuspid atresia, pulmonary atresia with intact ventricular septum Group 3 Left ventricular hypoplasia hypoplastic left heart syndrome and hypoplastic left heart complex Group 4 Double inlet type double inlet right ventricle and double inlet left ventricle Group 5 Biventricular type 2 unbalanced atrioventricular septal defect Table 2 Patients’ characteristics and surgical operative data. Variables All Patients 897 Male 512 (57%) Age at Fontan 4.5 (IQR 3.3–6.4) Weight at Fontan 16 (IQR 14–22) Prenatal Diagnosis 207 (58%) Unknown 540 Secondary/Additional Ventricular Chamber 199 (23%) Heterotaxy Syndrome 80 (8.9%) Syndrome/Chromosomal Abnormalities 22 (2.5%) Main cardiac diagnosis Right ventricular hypoplasia 283 (32%) Biventricular type 1 256 (29%) Left ventricular hypoplasia 174 (19%) Double inlet type 122 (14%) Biventricular type 2 62 (6.9%) Dominant Left /Right ventricle 479 (53%)/370 (41%) Undefined 48 (5.4%) First palliation Systemic to pulmonary artery shunt Norwood type, Damus-Kaye-Stensel Pulmonary artery band Other 710 (80%) 222 (25%) 224 (25%) 148 (17%) 116 (13%) Staged Fontan Bidirectional Glenn Bilateral Glenn Kawashima Hemifontan Other 829 (93%) 748 (84%) 37 (4.2%) 18 (2%) 13 (1.5%) 13 (1.5%) CPBP during Fontan staging 470 (96%) Fontan Type TCPC, Extracardiac ((median conduit 18 (IQ 16,20) 790 (88%) TCPC, Lateral Tunnel 87 (9.7%) Kreutzer, Bjork 12 (1.3%) Hepatic vein to Azygous Baffle, unknown, other 5 (0.6%) Fenestration 467 (52%) CPBP at Fontan completion 487 (95%) Table 3 Main postoperative data after Fontan Operation Postoperative characteristics All patients Onset of postoperative complication 410 (46%) Pleural effusion requiring chest tubes stay > 3 days Pleural effusion requiring chest tubes stay > 7 days (out of 269 patients) Unknown 283 (32%) 241 (85%) 370 Infection requiring antibiotic therapy > 7 days 63 (7%) Chylothorax 36 (4%) Bradicardia 33 (3.7%) IPPV > 24 hours 25 (2.8%) Fontan takedown 20 (2.2%) Tachycardia 20 (2.2%) AKI 19 (2.1%) LCO syndrome 17 (1.9%) Any reoperation 17 (1.9%) Bleeding requiring reoperation 16 (1.8%) Respiratory failure requiring IPPV > 3 days 15 (1.7%) Any cerebrovascular/neurological with complete resolution 9 (1%) Hemi-diaphragm paralysis 8 (0.9%) Any cerebrovascular/neurological with residual deficit 6 (0.7%) hemoptysis pulmonary bleeding 2 (0.2%) Other 49 (5%) ICU stay (days), median, IQR) 3 ( 2 , 4 ) Early Mortality 15 (1.7%) Early Reintervention 66 (7.5%) Yes, surgical 51 (5.8%) Yes, catheter intervention 15 (1.7%) Perioperative data included purely demographic and anatomical information (gender, prenatal diagnosis, type of congenital heart disease, ventricular dominance, presence of an additional ventricula chamber as described elsewhere ( 6 ). As mentioned, heterotaxy syndromes, extracardiac abnormalities, chromosomal abnormalities, Fontan intervention date and type (including procedure type - Bjork, Kreutzer, extracardiac conduit-ECC, lateral tunnel-LT - fenestration, palliation, and staging), use of extracorporeal circulation, need for deep hypothermia, complications, early mortality, any re-interventions, therapy, and discharge date were collected. In terms of postoperative complications, prolonged pleural effusions, arrhythmias, infections requiring antibiotic therapy for more than 7 days, chylothorax, transitional neurological events, and hemi-diaphragmatic paralysis were classified as minor adverse events (AEs), given their resolution without any clinical deficit. Major AEs included postoperative low cardiac output syndrome (LCOS), Fontan takedown, the need for prolonged mechanical support, major neurological events resulting in residual clinical disability, respiratory failure requiring invasive positive pressure ventilation (IPPV) for more than 3 days, acute kidney injury (AKI), bleeding necessitating reoperation, early death (within 30 days or during the hospital stay), or the need for any reintervention (surgical or percutaneous). Additionally, the study population was divided into three decades to gain a better understanding of advancements in the management of Fontan patients and to highlight differences in both surgical procedures and outcomes achieved. Last, the main cardiac diagnoses were arbitrarily divided into 5 groups (Table 1 ), according to the anatomical similarities and the presence of significantly large additional ventricular chambers, as above mentioned. Statistical analysis Continuous variables were described as medians (interquartile range [IQR]) and categorical variables as percentages. Statistical analysis was conducted using Fisher exact tests for categorical variables and non-parametric Mann-Whitney U tests for continuous variables. P-values were corrected for false discovery rate using the Benjamini-Hochberg method. Regressions were carried out as a generalized linear mixed model (GLMM) to accommodate both fixed (e.g. age at Fontan and cardiac diagnoses) and random effects. Specifically, the variable “center” identifying each institution was included as a random effect to account for the intragroup correlation inherent to the multicentric design of the study. All statistical analyses were carried out in the R (v.4.3.2) statistical computing environment. Results This study includes 893 patients (Male/Female=512/384) undergoing Fontan operation in 9 Italian tertiary centers for congenital cardiac disease from January 1, 1990, to January 31, 2023. Median age and weight at Fontan were 4.5 years (IQR 3.3 -6.4) and 16 kg (IQR 14-22), respectively. Prenatal diagnosis was available in 207 patients (58%). Dominant ventricular morphology was left in 479 patients (53%), and right in 370 patients (41%). An additional ventricular chamber was reported in 199 patients (23%). Heterotaxy syndrome was diagnosed in 80 patients (8.9%). The main cardiac diagnoses (Table 1, 2) were Right ventricular hypoplasia in 283 patients (32%), Biventricular type 1 in 256 patients (29%), Left ventricular hypoplasia in 174 patients (19%), Double inlet type in 122 patients (14%) and Biventricular type 2 in 62 patients (6.9%). Only 22 patients were associated with chromosomal abnormalities or syndromes (2.5%). An initial palliation procedure was conducted in 710 patients (80%), and the majority of patients underwent a staged Fontan pathway (829 patients, 93%), involving cavo-pulmonary anastomosis in 785 patients (88.2%). Fontan completion was predominantly achieved using an ECC in 790 patients (88%) (median conduit 18 (IQ 16,20), followed by the LT technique in 87 patients (9.7%), and atrio-pulmonary (Kreutzer) or atrial-ventricular (Bjork) connection in 12 patients (1.3%). Other or unspecified techniques were employed in 5 patients (0.6%) (Table 2). A fenestration was performed in 467 patients (52%) (Table 2). Notably, the utilization of ECC exhibited a progressive increase and emerged as the most prevalent surgical technique in recent years (Graph 1, Table 4). Table 4: Types of Fontan Operation through the decades Type of Fontan Operation 1990-1999 2000-2009 2010-2023 APP 9 (7.5%) 2 (0.6%) 1 (0.2%) ECC 67 (56%) 304 (92%) 419 (96%) LT 44 (37%) 26 (7.8%) 17 (3.9%) The overall incidence of complications in the entire population was 46% (410 patients) (Table 3). Given the most common Fontan complication, namely pleural effusions, we lacked data on the exact drainage maintenance (days) for 370 patients (41.4%). However, among all the remaining, 283 had chest tubes left in place for more than 3 days, as anticipated due to the substantial susceptibility of Fontan patients to effusions. Additionally, among these patients, the median duration of chest tube placement was 7 days, with 241 out of 283 (85%) requiring pleural drainage for more than 7 days. Early reinterventions (within 30 days or during the same hospitalization) were required in 7.5% (66 patients): surgical in 51 (5.8%), interventional-percutaneous in 15 (1.87%). Early mortality was 1.7% (15 patients). Main postoperative data are summarized in Table 3. Notably, the total number of patients undergoing Fontan operation has increased consistently over time, while early mortality and incidence of surgical reinterventions have drastically decreased (from 3.31% to 1.35%, and 7.44% to 5.41%, respectively) (Graph 2, Table 5). Table 5: Incidences of the main postoperative complications divided by decade. Decades major complication minor complication early death early surgical reintervention early catheter reintervention 1990-1999 11.6% 20.7% 3.31% 7.44% 0% 2000-2009 9.94% 34.6% 1.51% 7.23% 2.41% 2010-2023 9.46% 40.5% 1.35% 5.41% 3.83% There were no statistically significant differences in terms of postoperative complications, mortality, and rate of early reinterventions between genders (p-value 0.9), nor according to the main cardiac diagnosis (p-value 0.4, 0.5, 0.5 respectively) (table 6), dominant ventricular morphology (p-value 0.7, 0.8, 0.4 respectively), or the presence of an additional ventricular chamber (p-value >0.9, 0.8, >0.9 respectively). It is of note that the onset of postoperative chylothorax was significantly associated with CHD with right ventricular dominance (FSRV) when compared to left ventricle dominance (p-value 0.03). Additionally, the presence of a surgical fenestration was associated with a higher incidence of percutaneous reinterventions (p-value 0.015), while non-fenestrated patients exhibited a greater tendency towards drainage duration exceeding 3 days (p-value 0.002) (table 7). Table 6: Analysis of the associations between main cardiac diagnosis and the incidence in the main postoperative outcomes. Characteristics Double inlet type (N=122) Left ventricular hypoplasia (N= 174) Biventricular type 1 (N= 256) Right ventricular hypoplasia (N= 283) Biventricular type 2 (N= 62) Double inlet type vs left ventricular hypoplasia adj p-value Double inlet type vs Biventricular type 1 adj p-value Left ventricular hypoplasia vs biventricular type 1 adj p-value Double inlet type vs right ventricular hypoplasia adj p-value Left ventricular hypoplasia vs right ventricular hypoplasia adj p-value Biventricular type 1 vs right ventricular hypoplasia adj p-value Double inlet type vs Biventricular type 2 adj p-value Left ventricular hypoplasia vs biventricular type 2 adj p-value Biventricular type 1 vs Biventricular type 2 adj p-value right ventricular hypoplasia vs biventricular type 2 adj p-value Postoperative complications 51 (42%) 78 (45%) 131 (51%) 127 (45%) 23 (38%) 0.7 0.5 0.5 0.7 >0.9 0.5 0.7 0.6 0.5 0.6 LCO syndrome 3 (2.5%) 0 (0%) 6 (2.3%) 6 (2.1%) 2 (3.2%) 0.13 >0.9 0.13 >0.9 0.13 >0.9 >0.9 0.13 >0.9 >0.9 Bradicardia 1 (0.8%) 11 (6.3%) 12 (4.7%) 5 (1.8%) 4 (6.5%) 0.09 0.09 0.6 0.6 0.09 0.09 0.09 >0.9 0.6 0.09 Pleural effusion > 3 days 64 (80%) 88 (84%) 133 (88%) 120 (76%) 26 (84%) 0.7 0.4 0.7 0.7 0.4 0.088 0.7 >0.9 0.7 0.7 Early death 1 (0.8%) 3 (1.7%) 3 (1.2%) 5 (1.8%) 3 (4.8%) 0.8 0.8 0.8 0.8 >0.9 0.8 0.4 0.5 0.4 0.5 Early surgical reintervention 5 (4.1%) 7 (4%) 20 (7.8%) 20 (7.1%) 5 (8.1%) >0.9 0.4 0.4 0.4 0.4 >0.9 0.4 0.4 >0.9 >0.9 Early catheter reintervention 4 (3.3%) 4 (2.3%) 8 (3.1%) 8 (2.8%) 1 (1.6%) >0.9 >0.9 >0.9 >0.9 >0.9 >0.9 >0.9 >0.9 >0.9 >0.9 Table 7: Analysis of the associations between some demographic’s features and the incidence in the main postoperative outcomes. Early death Adj p-value Postoperative Complication Adj p-value LCO syndrome Adj p-value Arrythmias (Bradi) Adj p-value Pleural effusion > 3 days Adj p-value Early reintervention surgical Adj p-value Early reintervention catheter Adj p-value Early reintervention surgical + catheter Adj p-value Prenatal diagnosis: No Yes 3 (2%) 3 (1.5%) 0.8 6 (4%) 2 (1%) 0.3 10 (6.7%) 8 (3.9%) 0.5 105 (87%) 128 (83%) 0.6 15 (10%) 11 (5.3%) 0.3 7 (4.7%) 9 (4.3%) 0.9 20 (13%) 19 (9.2%) 0.5 Dominant Ventricular Morphology: Left vs other Left vs right right vs other 8 (1.7%) vs 1 (2.1%) 8 (1.7%) vs 6 (1.6%) 6 (1.6%) vs 1 (2.1%) 0.9 0.9 0.9 211 (45%) vs 24 (50%) 211 (45%) vs 175 (47%) 175 (47%) vs 24 (50%) 0.7 0.7 0.7 9 (1.9%) vs 3 (6.3%) 9 (1.9%) vs 5 (1.4%) 5 (1.4%) vs 3 (6.3%) 0.08 0.6 0.06 12 (2.5%) vs 3 (6.3%) 12 (2.5%) vs 18 (4.9%) 18 (4.9%) vs 3 (6.3%) 0.2 0.2 0.7 210 (78%) vs 34 (97%) 210 (78%) vs 187 (85%) 187 (85%) vs 34 (97%) 0.022 0.056 0.056 31 (6.5%) vs 5 (10%) 31 (6.5%) vs 21 (5.7%) 21 (5.7%) vs 5 (10%) 0.5 0.6 0.6 11 (2.3%) vs 3 (6.3%) 11 (2.3%) vs 11 (3%) 11 (3%) vs 3 (6.3%) 0.3 0.5 0.4 40 (8.4%) vs 7 (15%) 40 (8.4%) vs 31 (8.4%) 31 (8.4%) vs 7 (15%) 0.2 0.9 0.2 Additional ventricular chamber: No Yes 10 (1.5%) 0 (0%) 0.8 299 (45%) 93 (47%) 0.9 11 (1.6%) 4 (2%) 0.9 24 (3.6%) 9 (4.5%) 0.9 321 (81%) 95 (88%) 0.8 44 (6.5%) 13 (6.5%) 0.9 21 (3.1%) 4 (2%) 0.9 62 (9.2%) 16 (8%) 0.9 Fenestration: No Yes 7 (1.6%) 8 (1.7%) 0.9 196 (46%) 214 (47%) 0.9 4 (0.9%) 13 (2.8%) 0.1 15 (3.5%) 18 (3.9%) 0.9 199 (88%) 232 (77%) 0.02 27 (6.3%) 30 (6.4%) 0.9 6 (1.4%) 19 (4.1%) 0.015 33 (7.7%) 45 (9.6%) 0.6 Age at Fontan: > 4 years < 4 years 6 (1.1%) 9 (2.5%) 0.2 265 (50%) 145 (40%) 0.017 9 (1.7%) 8 (2.2%) 0.8 19 (3.6%) 14 (3.9%) 0.9 312 (86%) 119 (72%) <0.001 28 (5.2%) 29 (8%) 0.2 21 (3.9%) 4 (1.1%) 0.037 45 (8.4%) 33 (9.1%) 0.9 When comparing ECC vs LT, in this series, the latter was associated with a greater incidence of LCO syndrome and early mortality (adj p-value 0.024 adj p-value 0.005) (table 8). Table 8: Analysis of the associations between type of Fontan Operation and the incidence in the main postoperative outcomes. Characteristics Kreutzer/Bjork (N= 12) Hepatic vein to Azygos baffle (N= 5) TCPC extracardiac conduit (N= 788) TCPC Lateral tunnel (N= 85) Kreutzer/Bjork vs Hepatic vein to azygos baffle adj p-value Kreutzer/Bjork vs TCPC extracardiac conduit adj p-value Hepatic vein to azygos baffle vs TCPC extracardiac conduit adj p-value Kreutzer/Bjork vs TCPC lateral tunnel adj p-value Hepatic vein to azygos baffle vs TCPC lateral tunnel adj p-value TCPC extracardiac conduit vs TCPC lateral tunnel adj p-value Postoperative complications 9 (75%) 5 (100%) 345 (44%) 48 (57%) 0.3 0.062 0.06 0.3 0.091 0.06 LCO syndrome 1 (8.3%) 0 (0%) 11 (1.4%) 5 (5.7%) 0.8 0.15 0.8 0.8 0.8 0.024 Bradicardia 0 (0%) 1 (20%) 29 (3.7%) 3 (3.4%) 0.3 0.6 0.3 0.6 0.3 >0.9 Early death 0 (0%) 0 (0%) 9 (1.1%) 5 (5.8%) - 0.8 0.8 0.8 0.8 0.005 Early surgical reintervention 0 (0%) 1 (20%) 52 (6.6%) 4 (4.6%) 0.5 0.5 0.5 0.5 0.5 0.5 Early catheter reintervention 0 (0%) 0 (0%) 22 (2.8%) 1 (1.1%) - 0.8 0.8 0.8 0.8 0.8 Pleural effusion > 3 days 6 (75%) 4 (80%) 373 (86%) 46 (61%) >0.9 0.6 0.8 0.6 0.6 <0.001 Of note, we observed that age exceeding 4 years at Fontan completion was significantly correlated with a higher incidence of postoperative complications (p = 0.017), particularly concerning the requirement for early non-surgical reintervention (p = 0.037) and higher incidence of pleural drainage maintenance (p < 0.001) (Table 7). In conducting logistic regression analysis, with age treated as a continuous variable and adjusted for fenestration, age emerged as an independent risk factor for the composite outcome of postoperative complications, early reintervention, and early mortality. Specifically, with each additional year of age at the time of the Fontan procedure, the risk of experiencing all three outcomes increased by 7% (Table 9). Table 9: Logistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan and fenestration as covariates. Characteristic OR 95% CI p-value Age at Fontan 1.07 1.03-1.1 <0.001 Fenestration no - - yes 1.08 0.83-1.41 0.6 However, in regression analysis, when age was further adjusted for other variables (main cardiac diagnosis or type of Fontan surgery), the impact of age diminished when considering anatomical and surgical factors. This suggests that the tendency toward increased complications is more closely associated with underlying anatomical conditions rather than age at surgery (see Tables 10, 11). Table 10: Logistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan, and type of Fontan operation as covariates. Characteristic OR 95% CI p-value Age at Fontan 1 0.97-1.04 >0.9 Fenestration no - - yes 1.09 0.76-1.58 0.6 Type of Fontan Atrial-pulmonary connection (Kreutzer), Atrial-ventricular connection (Bjork) - - Hepatic vein to azygous Baffle, Unknown/Not documented, other 5,264,973 0-inf >0.9 TCPC Extracardiac conduit 0.66 0.16-2.7 0.6 TCPC Lateral Tunnel 0.43 0.1-1.87 0.3 Table 11: Logistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan and main cardiac diagnosis as covariates. Characteristic OR 95% CI p-value Age at Fontan 1.01 0.97-1.04 0.8 Fenestration no - - yes 1.03 0.72-1.49 0.9 Fundamental cardiac diagnosis DILV/DIRV - - HLHS, Hypoplastic left heart complex 1.67 0.95-2.91 0.073 TGA, DORV, DOLV, MA, Criss cross heart, Ebstein's Anomaly 1.78 1.05-3 0.031 TA, Pulmonary PA-IVS 1.45 0.87-2.42 0.2 Unbalanced CAVC 1.19 0.54-2.62 0.7 Regarding cardiac diagnosis, the median age at Fontan for each group of heart defects was calculated, revealing a statistically significant difference between the groups (adjusted p-value < 0.001). A boxplot illustrating the distribution of age at Fontan relative to the type of cardiac diagnosis is presented (Fig. 1). Last, as anticipated, the majority of patients (66%) undergoing the LT had a median age of while 62% of median age of patients undergoing the ECC was significantly higher than those who had LT (4.6 years -IQ 3.4-6.5, versus 3.5 -IQ 2.5 – 5, adjusted p-value < 0.001). Discussion Fontan palliation has emerged as a standard procedure for patients with FSV. Since its inception ( 7 ), there have been significant improvement in the early outcomes of Fontan circulation. The mortality rate, once high in the 1980s ( 8 , 9 ), have decreased to approximately 2–4%, according to data from the ECHSA congenital database ( https://echsacongenitaldb.org ) and other previously cited reports ( 2 – 4 ). Over the past thirty years, the original Fontan surgical technique has undergone various modifications, evolving from the initial techniques proposed by Bjork and Kreutzer ( 10 , 11 ) to the refined methodology introduced by Marcelletti ( 12 ). In our study population, the ECC has emerged as the preferred surgical approach (Table 4 , Graph 1), followed by the LT ( 13 – 15 ), particularly in younger pediatric patients, as it avoids the use of small conduits which may cause a need for a late reoperation for conduit replacement. It appears that despite the use of diverse surgical techniques (namely ECC vs LT), there was not a significant difference in the occurrence of early complications overall. However, it's noteworthy that LT has shown a stronger association with the onset of LCO syndrome and early mortality compared to ECC. This difference in outcomes may be influenced by various factors (such as the patients’ BSA and age at operation, need to operate earlier). Additionally, in other studies comparing the LT vs ECC procedures, the former has been linked to higher rates of postoperative complications, particularly arrhythmias. This suggests that the choice of surgical approach may have implications for patient outcomes and warrants careful consideration in clinical decision-making ( 16 – 20 ). Within our study population, there has been a remarkable and continuous reduction in mortality, with an overall mortality rate of 1.7%, and an evident dropping from 3.31% in the 1990s to 1.35% more recently (Table 5 , graph 2). This trend is further highlighted when examining the data by decades, revealing a consistent decrease in mortality rates over time. This decline can be attributed to advancements in surgical techniques, improvements in preoperative patient selection, and enhancements in postoperative management protocols. Conversely, there has been a notable increase in overall complications, impacting a substantial portion of our cohort (46%). This trend aligns with previous findings reported in 2012, where a large multicenter study involving 2747 patients undergoing TCPC with lateral tunnel (LT) versus extracardiac conduit (ECC) in the USA documented a complication rate of 40.4% ( 21 , 22 ). However, upon scrutinizing these complications, it becomes evident that minor complications and the need for non-surgical reintervention have escalated (from 20.7–40.5%, from 0–3.83% respectively), juxtaposed with a reduction in total major complications (from 11.6–9.46%) and surgical need of reintervention (from 7.44–5.41%) (Table 5 , graph 2). This trend through decades in mortality and incidence of complications mirrors the one observed in other scientific studies. In an Italian report published in the 90s, the rate of early mortality was 10%, of early Fontan failure was 15%, of Fontan takedown was 10%, and of overall surgical reintervention was 16.6% (Fontan takedown, stenotic anastomosis, plication of hemidiaphragm) ( 23 ). In contrast, in a more recent and previously cited study, released in 2012, the researchers analyzed 2747 Fontan patients and the in-hospital mortality turned out to be 1.6% with a Fontan takedown/revision rate of 1.4% ( 21 ). Persistent pleural effusions and prolonged chest tube stay are well known postoperative complications after Fontan ( 3 , 4 , 7 , 8 , 16 , 20 – 22 ). In our series, the median duration of chest tube placement was 7 days, consistent with findings reported by others ( 16 ). Also, 241 (89.6% of those requiring prolonged chest tube stay) had their chest tubes in place for more than 7 days. This extended timeframe confirms the persistent nature of the postoperative effusion issue, potentially influenced also by the prevalent practice of prolonged chest tube insertion in Fontan patients, who have a known propensity for effusion. Notably, a higher percentage of non-fenestrated patients had prolonged chest tube retention compared to fenestrated patients (88% vs. 77%; p-value 0.019). This finding underscores the potential impact of fenestration on postoperative drainage management in Fontan patients. Further data analyses are necessary to delve deeper into this observation and understand its implications fully. Notably, when assessing the clinical impact of ventricular dominance on early outcomes, we did not find any statistically significant differences in the occurrence of major adverse events, other than a higher incidence of chylothorax in patients with right ventricular dominance (5.7% vs 2.5%; p-value 0.03). Recent findings by Ponzoni et al. suggested that Fontan patients with a right-dominant ventricle exhibit inferior long-term survival, especially when the anatomical right ventricle is part of the systemic circulation ( 24 ). Also, Pollak et al ( 25 ) highlighted prolonged postoperative hospitalization, along with poorer early postoperative indicators (ventricular dysfunction and atrioventricular valve regurgitation), in patients with right ventricular morphology compared to those with left ventricular morphology. A study by Ovroutski et al. ( 26 ) suggested right ventricle morphology as a risk factor for early Fontan failure. Our observations suggest that the early postoperative course following the Fontan operation may be influenced by the effective systolic and diastolic function of the ventricular chamber, regardless of its morphology. One noteworthy finding from our research pertains to the age at Fontan completion. Presently, there exists no consensus among clinicians or surgeons regarding the optimal timing of Fontan completion. Some studies have reported no statistically significant differences in early outcomes, morbidity, or mortality based on age ( 27 , 28 ). Other reports showed that an age of approximately 4 years or younger, at the time of Fontan completion, is associated with better outcomes, both in the short and long term ( 29 ). In contrast, higher age has been associated with the need for revision surgery, and late death ( 20 , 30 ), Fontan failure, a decline in exercise capacity, and a reduction in cardiac index ( 31 – 34 ). In a study of 3319 patients, published by Akintoye et al. in 2018, the age of 3 years was identified as the optimum for Fontan completion, as evidenced by a lower rate of in-hospital mortality, procedure‐related complications, and rate of nonroutine home discharge ( 29 ). However, a study by Pace Napoleone et al. ( 35 ), affirmed that the modified Fontan operation can be performed safely in older patients without affecting operative and medium-term follow-up results. They divided their cohort into two groups according to the age of 7 years old at the time of Fontan completion. Mortality (respectively 0% in group 7 years; p = 0.5) and complications were similar between the two groups. As D’Udekem et al reported ( 36 ), the ‘ticking clock theory’ advocates that any Fontan circulation will have a limited lifetime so the decision regarding the age at which to perform the Fontan procedure is challenging. Delaying the intervention poses a high risk of paradoxical embolism and side effects associated with chronic cyanosis. On the other hand, performing the procedure early entails a heightened risk of elevated pulmonary resistance, systemic venous hypertension, arrhythmias, and low oxygen saturation. In our cohort of Fontan patients, the median age was 4 years, which we used as a cutoff to divide our cohort. Upon analyzing the overall incidence of complications, we observed that patients older than 4 years exhibited a higher occurrence of poor early outcomes compared to those younger than 4 years (50% vs 40%; adjusted p-value 0.017). We also noted a correlation with percutaneous reinterventions (3.9% vs 1.1%; adjusted p-value 0.037) and drainage duration exceeding 3 days (86% vs 72%; adjusted p-value < 0.001). Our logistic regression analysis, which included age as a continuous variable and was adjusted for fenestration, identified age as an independent relative risk factor. Specifically, for each additional year at the time of Fontan operation, there was a 7% increase in the risk of encountering complications. However, upon additional adjustment for other variables such as main cardiac diagnosis or type of Fontan operation, the significance of age as a risk factor diminished. This suggests that despite younger age seems to be a protective factor for early outcomes, the impact of age on complication risk may be also influenced by the specific procedural approach utilized and the underlying cardiac pathology, rather than age itself being an inherent risk factor. Study limitations As a retrospective multicenter study, there may have been selection bias; however, we endeavored to mitigate this bias by including centers with varying Fontan completion volumes and encompassing all Fontan procedures at each center. While we have comprehensive preoperative and operative data on all enrolled patients, disparities in postoperative ICU time and missing data could have impacted our results. Additionally, due to the extensive time frame covered by our cohort, the loss of certain anatomical details and perioperative data was unavoidable and may have influenced our findings. Conclusion The perioperative outcomes of the Fontan procedure have shown a consistent and notable improvement over the past thirty years in Italy. Mortality rates have steadily decreased from 3.31–1.35% across the decades. Among the various surgical techniques utilized, the ECC method has emerged as both the most frequently employed and the safest option, associated with fewer postoperative complications compared to alternative approaches. However, our analysis has revealed that age exceeding 4 years at the time of Fontan completion may represent a significant risk factor for the development of complications, reinterventions, and early mortality. This emphasizes the critical role of considering patient age as a pivotal factor in the planning and execution of the Fontan procedure. By carefully considering age in surgical decision-making, healthcare professionals can strive for optimal outcomes and mitigate potential risks associated with Fontan surgery. Declarations Author Contribution I.C. and E.B. Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Software; Visualization; Writing – original draft; Writing – review & editingM.P. Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing – review & editingL.V. Formal analysis; Methodology; Software; ValidationG.G. Data Curation; review & editingV.L.V. Supervision; ValidationA.G. Validation; review & editingL.G., G.B., M.T., M.P., G.D.G, E.A., L.C., R.Z., C.P.N, L.D.O., F.S., A.G., M.L., S.M.M., S.A., E.B., U.V., G.M., G.S., G.S., H.N., G.M., R.B., A.G., G.D. Data curation; Investigation; All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication. Data Availability Data that support the findings of this study have been collected and deposited in https://research.dctv.unipd.it/redcap/Data are protected with user and password and avaiable through reasonable request References Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. 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Congenit Heart Dis 14(2):138–139 Alphonso N, Baghai M, Sundar P, Tulloh R, Austin C, Anderson D (2005) Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. Eur J Cardiothorac Surg 28(4):529–535 Forsdick V, Iyengar AJ, Carins T, Gentles TL, Weintraub RG, Celermajer DS et al (2015) Unsatisfactory Early and Late Outcomes After Fontan Surgery Delayed to Adolescence and Adulthood. Semin Thorac Cardiovasc Surg 27(2):168–174 d’Udekem Y, Iyengar AJ, Galati JC, Forsdick V, Weintraub RG, Wheaton GR et al (2014) Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 130(11 Suppl 1):S32–38 Ovroutski S, Ewert P, Miera O, Alexi-Meskishvili V, Peters B, Hetzer R et al (2010) Long-term cardiopulmonary exercise capacity after modified Fontan operation. Eur J Cardiothorac Surg 37(1):204–209 Shiraishi S, Yagihara T, Kagisaki K, Hagino I, Ohuchi H, Kobayashi J et al (2009) Impact of age at Fontan completion on postoperative hemodynamics and long-term aerobic exercise capacity in patients with dominant left ventricle. Ann Thorac Surg 87(2):555–560 discussion 560–561 Pace Napoleone C, Oppido G, Angeli E, Giardini A, Resciniti E, Gargiulo G (2010) Results of the modified Fontan procedure are not related to age at operation. Eur J Cardiothorac Surg 37(3):645–650 d’Udekem Y, Xu MY, Konstantinov IE (2011) The optimal age at Fontan procedure and the ‘ticking clock’ theory: do we have an answer? Eur J Cardiothorac Surg. ;39(1):144; author reply 144–145 Graph Graph 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files g1.png Graphs 1: Type of Fontan Operation through the last three decades. g2.png Graph 2: Representation of the incidences of the main postoperative complications divided by decade. Cite Share Download PDF Status: Published Journal Publication published 17 Sep, 2024 Read the published version in Pediatric Cardiology → Version 1 posted Editorial decision: Revision requested 18 Jun, 2024 Reviews received at journal 17 Jun, 2024 Reviewers agreed at journal 17 May, 2024 Reviewers agreed at journal 16 May, 2024 Reviewers agreed at journal 14 May, 2024 Reviewers invited by journal 14 May, 2024 Editor assigned by journal 18 Apr, 2024 Submission checks completed at journal 18 Apr, 2024 First submitted to journal 17 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4283962","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":294168263,"identity":"72df13ca-c547-4cd4-8cfc-90517f1234e5","order_by":0,"name":"Irene Cao","email":"","orcid":"","institution":"Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Irene","middleName":"","lastName":"Cao","suffix":""},{"id":294168265,"identity":"628ec209-50ff-4537-ab27-0ed7e0c0c836","order_by":1,"name":"Emma Bergonzoni","email":"","orcid":"","institution":"Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Emma","middleName":"","lastName":"Bergonzoni","suffix":""},{"id":294168266,"identity":"195e6712-dfc0-45d7-911f-0cbdeb21f6f1","order_by":2,"name":"Luca Vedovelli","email":"","orcid":"","institution":"Università di Padova","correspondingAuthor":false,"prefix":"","firstName":"Luca","middleName":"","lastName":"Vedovelli","suffix":""},{"id":294168267,"identity":"262156e7-b5b6-4f6b-a2dc-f4b7c42e4f3f","order_by":3,"name":"Giulia Guerra","email":"","orcid":"","institution":"Department of Cardiac Surgery Unit, Thoracic, Vascular Sciences and Public Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Giulia","middleName":"","lastName":"Guerra","suffix":""},{"id":294168268,"identity":"f9873e17-7323-4e76-9e95-010dd763dbe3","order_by":4,"name":"Lorenzo Galletti","email":"","orcid":"","institution":"Pediatric Hospital Bambino Gesù","correspondingAuthor":false,"prefix":"","firstName":"Lorenzo","middleName":"","lastName":"Galletti","suffix":""},{"id":294168269,"identity":"fb5afd83-88cd-4835-b841-31ad9bb575a1","order_by":5,"name":"Gianfranco Butera","email":"","orcid":"","institution":"Pediatric Hospital Bambino Gesù","correspondingAuthor":false,"prefix":"","firstName":"Gianfranco","middleName":"","lastName":"Butera","suffix":""},{"id":294168284,"identity":"4b6f3916-a28e-404e-9a70-e41f1435a7cb","order_by":6,"name":"Matteo Trezzi","email":"","orcid":"","institution":"Pediatric Hospital Bambino Gesù","correspondingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Trezzi","suffix":""},{"id":294168297,"identity":"23f9387b-4f66-49f9-9a2e-fefc6b5dbd8e","order_by":7,"name":"Mario Panebianco","email":"","orcid":"","institution":"Pediatric Hospital Bambino Gesù","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Panebianco","suffix":""},{"id":294168299,"identity":"17d6b1ae-7647-4712-9cb3-105d5c5faf88","order_by":8,"name":"Gaetano D. 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Marianeschi","email":"","orcid":"","institution":"Unità di Cardiochirurgia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda","correspondingAuthor":false,"prefix":"","firstName":"Stefano","middleName":"M.","lastName":"Marianeschi","suffix":""},{"id":294168318,"identity":"c6b09982-99c0-4d06-af67-c6fb42c4713b","order_by":19,"name":"Salvatore Agati","email":"","orcid":"","institution":"Unità di Cardiochirurgia Pediatrica, Ospedale San Vincenzo","correspondingAuthor":false,"prefix":"","firstName":"Salvatore","middleName":"","lastName":"Agati","suffix":""},{"id":294168319,"identity":"1f4875e2-df71-449a-b34b-779d0b3c7446","order_by":20,"name":"Ermanno Bellanti","email":"","orcid":"","institution":"Unità di Cardiochirurgia Pediatrica, Ospedale San Vincenzo","correspondingAuthor":false,"prefix":"","firstName":"Ermanno","middleName":"","lastName":"Bellanti","suffix":""},{"id":294168320,"identity":"05cfe087-1a17-4418-9a8d-fb6d51f9c1c1","order_by":21,"name":"Ugo Vairo","email":"","orcid":"","institution":"Unità di Cardiologia Pediatrica, Ospedale Giovanni XXIII","correspondingAuthor":false,"prefix":"","firstName":"Ugo","middleName":"","lastName":"Vairo","suffix":""},{"id":294168321,"identity":"ab94de88-8d7d-4281-89b5-4dee581ad0fe","order_by":22,"name":"Giovanni Meliota","email":"","orcid":"","institution":"Unità di Cardiologia Pediatrica, Ospedale Giovanni XXIII","correspondingAuthor":false,"prefix":"","firstName":"Giovanni","middleName":"","lastName":"Meliota","suffix":""},{"id":294168323,"identity":"855daac2-fdce-4218-b6f8-52f21d046aa0","order_by":23,"name":"Gabriele Scalzo","email":"","orcid":"","institution":"Ospedale Giovanni XXIII","correspondingAuthor":false,"prefix":"","firstName":"Gabriele","middleName":"","lastName":"Scalzo","suffix":""},{"id":294168326,"identity":"cb322314-71ef-4735-b949-ae3e94486dd5","order_by":24,"name":"Giuseppe Scrascia","email":"","orcid":"","institution":"Ospedale Giovanni XXIII","correspondingAuthor":false,"prefix":"","firstName":"Giuseppe","middleName":"","lastName":"Scrascia","suffix":""},{"id":294168329,"identity":"6b9f14f8-1b64-4798-bdf0-97c308f51b60","order_by":25,"name":"Halkawt Nuri","email":"","orcid":"","institution":"Unità di Cardiochirurgia Pediatrica, Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Halkawt","middleName":"","lastName":"Nuri","suffix":""},{"id":294168332,"identity":"19e71569-e539-4ba1-b5c0-fee83b51a69c","order_by":26,"name":"Guido Michielon","email":"","orcid":"","institution":"Unità di Cardiochirurgia Pediatrica, Istituto Giannina Gaslini","correspondingAuthor":false,"prefix":"","firstName":"Guido","middleName":"","lastName":"Michielon","suffix":""},{"id":294168335,"identity":"ebd7b810-6a13-4013-9849-00a64782207b","order_by":27,"name":"Roberta Biffanti","email":"","orcid":"","institution":"Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Roberta","middleName":"","lastName":"Biffanti","suffix":""},{"id":294168337,"identity":"7788873e-b0df-4c83-8020-e51aa31225d5","order_by":28,"name":"Anna Gozzi","email":"","orcid":"","institution":"Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Gozzi","suffix":""},{"id":294168339,"identity":"338dc8fa-55aa-4c0c-ae6a-96770f8ad8d2","order_by":29,"name":"Giovanni Salvo","email":"","orcid":"","institution":"Division of Pediatric Cardiology, Departments of Women's and Children's Health, University of Padua","correspondingAuthor":false,"prefix":"","firstName":"Giovanni","middleName":"","lastName":"Salvo","suffix":""},{"id":294168341,"identity":"7f021534-8d01-488f-a42f-305d21c76c43","order_by":30,"name":"Vladimiro L. Vida","email":"","orcid":"","institution":"Università di Padova","correspondingAuthor":false,"prefix":"","firstName":"Vladimiro","middleName":"L.","lastName":"Vida","suffix":""},{"id":294168342,"identity":"16826053-b060-450a-a20d-4f915742cffe","order_by":31,"name":"Massimo A. Padalino","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYLCCBAhlwPDAgIGBH8g6DMQ8xGlJAGqRbIBqwa8HrgVEHmBgYGbAY41u+/HHHx7m2DCYsx/e+CGh4I6c8Y3cg4cLahhk7HFoMTuTYyaRuC2NwbInrVgiweCZsdmNvITDM47hdpjZgRw2hsRth4HuyTEAajmcuO1GjsFhHjY8Ws4/f/wBrOX8G+MfIC2bZ4C0/MOj5UaCgQRYyw2gC0FaNkgAtfC24dPyBuwXHssZz8osgFqMJc68MTg8s0+Ch+cALoelP/74c5uNnDl/8uYbH/4cluNvzzH+XPDNxp69AYc1UMBjgCYggV89CKBrGQWjYBSMglEABwDQnVyB1mZnRgAAAABJRU5ErkJggg==","orcid":"","institution":"Università di Padova","correspondingAuthor":true,"prefix":"","firstName":"Massimo","middleName":"A.","lastName":"Padalino","suffix":""}],"badges":[],"createdAt":"2024-04-17 20:59:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4283962/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4283962/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00246-024-03642-2","type":"published","date":"2024-09-17T15:57:08+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55381435,"identity":"f07cc830-dc02-4b77-b65d-362a0da04681","added_by":"auto","created_at":"2024-04-26 13:50:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":172683,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot showing the distribution of age at Fontan concerning the type of cardiac diagnosis.\u003c/p\u003e\n\u003cp\u003eμ median = median age.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4283962/v1/7fd5c8069a30308630dd4141.png"},{"id":65103912,"identity":"93125c6e-c0e3-4dd1-8202-fb6225885230","added_by":"auto","created_at":"2024-09-23 16:09:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1655165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4283962/v1/573bf1a5-8219-4a55-8556-20898dfaf5ca.pdf"},{"id":55381437,"identity":"f97261e7-cd88-4389-8477-99910e7c332f","added_by":"auto","created_at":"2024-04-26 13:50:50","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34197,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphs 1: \u003c/strong\u003eType of Fontan Operation through the last three decades.\u003c/p\u003e","description":"","filename":"g1.png","url":"https://assets-eu.researchsquare.com/files/rs-4283962/v1/6f7b5144634d12a8ba0cc970.png"},{"id":55381436,"identity":"147225bb-9dec-45bf-968e-54011f5df9a2","added_by":"auto","created_at":"2024-04-26 13:50:50","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":46987,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 2: \u003c/strong\u003eRepresentation of the incidences of the main postoperative complications divided by decade.\u003c/p\u003e","description":"","filename":"g2.png","url":"https://assets-eu.researchsquare.com/files/rs-4283962/v1/d71a0ffe0b78af714ae6ff86.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePostoperative Outcomes of Fontan Operation in a Multicenter Italian Study. How Far Have We Gone?\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAfter the first repair for tricuspid atresia in Bordeaux in 1968 by Fontan and Baudet (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e), surgical indications to the so-called Fontan palliation have progressively expanded to include various complex congenital heart diseases (CHD) with a functional single ventricle (FSV). Postoperative outcomes have shown a steady improvement over the years, and the high mortality rates experienced in the \u0026rsquo;80s appear now to belong to the past (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Nevertheless, despite these achievements, the postoperative management after Fontan remains challenging, particularly because of the usually prolonged recovery period and the consistent incidence of pleural effusions. Additionally, the optimal age for Fontan completion continues to be a topic of debate (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe herein report our analysis in a large cohort of patients who underwent a Fontan completion in the last 3 decades, to assess current early results of Fontan operation and risk factors for early complications in a multicentric Italian study.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis is a multi-center retrospective observational study including patients with FSV undergoing Fontan completion between January 1990 and January 2023. This retrospective study was developed by the core institution (University of Padova, Italy). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki, as reflected in approval by each participating site\u0026rsquo;s ethical regulatory body. The overall study was approved by the Institutional Review Board at the University of Padova (nr. 20616, CESC code: 5423/AO/22) and by each participating center. The requirement for informed consent was waived given the study design.\u003c/p\u003e \u003cp\u003eClinical and surgical data were retrieved from medical records by local investigators and recorded in a secure online RedCap database between December 2021 and January 2023. Requested preoperative and postoperative data are described in detail in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGroups including all cardiac diagnosis according to anatomical similarities and the presence of a significant additional chamber\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiventricular type 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003etransposition of the great arteries, double outlet right and left ventricle, mitral atresia, criss cross heart, Ebstein anomaly.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight ventricular hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etricuspid atresia, pulmonary atresia with intact ventricular septum\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft ventricular hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ehypoplastic left heart syndrome and hypoplastic left heart complex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDouble inlet type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edouble inlet right ventricle and double inlet left ventricle\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiventricular type 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eunbalanced atrioventricular septal defect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristics and surgical operative data.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e897\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e512 (57%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at Fontan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.5 (IQR 3.3\u0026ndash;6.4)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWeight at Fontan\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e16 (IQR 14\u0026ndash;22)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrenatal Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e207 (58%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSecondary/Additional Ventricular Chamber\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e199 (23%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeterotaxy Syndrome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e80 (8.9%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSyndrome/Chromosomal Abnormalities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e22 (2.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain cardiac diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight ventricular hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e283 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiventricular type 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256 (29%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft ventricular hypoplasia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (19%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble inlet type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiventricular type 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDominant Left /Right ventricle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e479 (53%)/370 (41%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndefined\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFirst palliation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSystemic to pulmonary artery shunt\u003c/p\u003e \u003cp\u003eNorwood type, Damus-Kaye-Stensel\u003c/p\u003e \u003cp\u003ePulmonary artery band\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e710 (80%)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e222 (25%)\u003c/p\u003e \u003cp\u003e224 (25%)\u003c/p\u003e \u003cp\u003e148 (17%)\u003c/p\u003e \u003cp\u003e116 (13%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStaged Fontan\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBidirectional Glenn\u003c/p\u003e \u003cp\u003eBilateral Glenn\u003c/p\u003e \u003cp\u003eKawashima\u003c/p\u003e \u003cp\u003eHemifontan\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e829 (93%)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e748 (84%)\u003c/p\u003e \u003cp\u003e37 (4.2%)\u003c/p\u003e \u003cp\u003e18 (2%)\u003c/p\u003e \u003cp\u003e13 (1.5%)\u003c/p\u003e \u003cp\u003e13 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCPBP during Fontan staging\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e470 (96%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFontan Type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTCPC, Extracardiac ((median conduit 18 (IQ 16,20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e790 (88%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTCPC, Lateral Tunnel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKreutzer, Bjork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatic vein to Azygous Baffle, unknown, other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFenestration\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e467 (52%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCPBP at Fontan completion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e487 (95%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain postoperative data after Fontan Operation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnset of postoperative complication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e410 (46%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion requiring chest tubes stay\u0026thinsp;\u0026gt;\u0026thinsp;3 days\u003c/p\u003e \u003cp\u003ePleural effusion requiring chest tubes stay\u0026thinsp;\u0026gt;\u0026thinsp;7 days (out of 269 patients)\u003c/p\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e283 (32%)\u003c/p\u003e \u003cp\u003e241 (85%)\u003c/p\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection requiring antibiotic therapy\u0026thinsp;\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChylothorax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBradicardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPPV\u0026thinsp;\u0026gt;\u0026thinsp;24 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFontan takedown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCO syndrome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding requiring reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure requiring IPPV\u0026thinsp;\u0026gt;\u0026thinsp;3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny cerebrovascular/neurological with complete resolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemi-diaphragm paralysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny cerebrovascular/neurological with residual deficit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehemoptysis pulmonary bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eICU stay (days), median, IQR)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly Mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e15 (1.7%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEarly Reintervention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e66 (7.5%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, surgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes, catheter intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePerioperative data included purely demographic and anatomical information (gender, prenatal diagnosis, type of congenital heart disease, ventricular dominance, presence of an additional ventricula chamber as described elsewhere (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). As mentioned, heterotaxy syndromes, extracardiac abnormalities, chromosomal abnormalities, Fontan intervention date and type (including procedure type - Bjork, Kreutzer, extracardiac conduit-ECC, lateral tunnel-LT - fenestration, palliation, and staging), use of extracorporeal circulation, need for deep hypothermia, complications, early mortality, any re-interventions, therapy, and discharge date were collected. In terms of postoperative complications, prolonged pleural effusions, arrhythmias, infections requiring antibiotic therapy for more than 7 days, chylothorax, transitional neurological events, and hemi-diaphragmatic paralysis were classified as minor adverse events (AEs), given their resolution without any clinical deficit. Major AEs included postoperative low cardiac output syndrome (LCOS), Fontan takedown, the need for prolonged mechanical support, major neurological events resulting in residual clinical disability, respiratory failure requiring invasive positive pressure ventilation (IPPV) for more than 3 days, acute kidney injury (AKI), bleeding necessitating reoperation, early death (within 30 days or during the hospital stay), or the need for any reintervention (surgical or percutaneous). Additionally, the study population was divided into three decades to gain a better understanding of advancements in the management of Fontan patients and to highlight differences in both surgical procedures and outcomes achieved. Last, the main cardiac diagnoses were arbitrarily divided into 5 groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), according to the anatomical similarities and the presence of significantly large additional ventricular chambers, as above mentioned.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were described as medians (interquartile range [IQR]) and categorical variables as percentages. Statistical analysis was conducted using Fisher exact tests for categorical variables and non-parametric Mann-Whitney U tests for continuous variables. P-values were corrected for false discovery rate using the Benjamini-Hochberg method. Regressions were carried out as a generalized linear mixed model (GLMM) to accommodate both fixed (e.g. age at Fontan and cardiac diagnoses) and random effects. Specifically, the variable \u0026ldquo;center\u0026rdquo; identifying each institution was included as a random effect to account for the intragroup correlation inherent to the multicentric design of the study. All statistical analyses were carried out in the R (v.4.3.2) statistical computing environment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study includes 893 patients (Male/Female=512/384) undergoing Fontan operation in 9 Italian tertiary centers for congenital cardiac disease from January 1, 1990, to January 31, 2023. Median age and weight at Fontan were 4.5 years (IQR 3.3 -6.4) and 16 kg (IQR 14-22), respectively. Prenatal diagnosis was available in 207 patients (58%).\u003c/p\u003e\n\u003cp\u003eDominant ventricular morphology was left in 479 patients (53%), and right in 370 patients (41%). An additional ventricular chamber was reported in 199 patients (23%). Heterotaxy syndrome was diagnosed in 80 patients (8.9%).\u003c/p\u003e\n\u003cp\u003eThe main cardiac diagnoses (Table 1, 2) were Right ventricular hypoplasia in 283 patients (32%), Biventricular type 1 in 256 patients (29%), Left ventricular hypoplasia in 174 patients (19%), Double inlet type in 122 patients (14%) and Biventricular type 2 in 62 patients (6.9%). Only 22 patients were associated with chromosomal abnormalities or syndromes (2.5%).\u003c/p\u003e\n\u003cp\u003eAn initial palliation procedure was conducted in 710 patients (80%), and the majority of patients underwent a staged Fontan pathway (829 patients, 93%), involving cavo-pulmonary anastomosis in 785 patients (88.2%). Fontan completion was predominantly achieved using an ECC in 790 patients (88%) (median conduit 18 (IQ 16,20), followed by the LT technique in 87 patients (9.7%), and atrio-pulmonary (Kreutzer) or atrial-ventricular (Bjork) connection in 12 patients (1.3%). Other or unspecified techniques were employed in 5 patients (0.6%) (Table 2). A fenestration was performed in 467 patients (52%) (Table 2). Notably, the utilization of ECC exhibited a progressive increase and emerged as the most prevalent surgical technique in recent years (Graph 1, Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eTypes of Fontan Operation through the decades\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"563\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.898756660746%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Fontan Operation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.623445825932503%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1990-1999\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.518650088809945%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2000-2009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.959147424511546%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.898756660746%\"\u003e\n \u003cp\u003eAPP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.623445825932503%\"\u003e\n \u003cp\u003e9 (7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.518650088809945%\"\u003e\n \u003cp\u003e2 (0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.959147424511546%\"\u003e\n \u003cp\u003e1 (0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.898756660746%\"\u003e\n \u003cp\u003eECC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.623445825932503%\"\u003e\n \u003cp\u003e67 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.518650088809945%\"\u003e\n \u003cp\u003e304 (92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.959147424511546%\"\u003e\n \u003cp\u003e419 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.898756660746%\"\u003e\n \u003cp\u003eLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.623445825932503%\"\u003e\n \u003cp\u003e44 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.518650088809945%\"\u003e\n \u003cp\u003e26 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.959147424511546%\"\u003e\n \u003cp\u003e17 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe overall incidence of complications in the entire population was 46% (410 patients) (Table 3). Given the most common Fontan complication, namely pleural effusions, we lacked data on the exact drainage maintenance (days) for 370 patients (41.4%). However, among all the remaining, 283 had chest tubes left in place for more than 3 days, as anticipated due to the substantial susceptibility of Fontan patients to effusions. Additionally, among these patients, the median duration of chest tube placement was 7 days, with 241 out of 283 (85%) requiring pleural drainage for more than 7 days.\u003c/p\u003e\n\u003cp\u003eEarly reinterventions (within 30 days or during the same hospitalization) were required in 7.5% (66 patients): surgical in 51 (5.8%), interventional-percutaneous in 15 (1.87%). Early mortality was 1.7% (15 patients). Main postoperative data are summarized in Table 3.\u003c/p\u003e\n\u003cp\u003eNotably, the total number of patients undergoing Fontan operation has increased consistently over time, while early mortality and incidence of surgical reinterventions have drastically decreased (from 3.31% to 1.35%, and 7.44% to 5.41%, respectively) (Graph 2, Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eIncidences of the main postoperative complications divided by decade.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"641\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.541341653666144%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecades\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.068642745709827%\"\u003e\n \u003cp\u003e\u003cstrong\u003emajor complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.976599063962558%\"\u003e\n \u003cp\u003e\u003cstrong\u003eminor complication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45241809672387%\"\u003e\n \u003cp\u003e\u003cstrong\u003eearly death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\"\u003e\n \u003cp\u003e\u003cstrong\u003eearly surgical reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\"\u003e\n \u003cp\u003e\u003cstrong\u003eearly catheter reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.541341653666144%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e1990-1999\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.068642745709827%\" valign=\"bottom\"\u003e\n \u003cp\u003e11.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.976599063962558%\" valign=\"bottom\"\u003e\n \u003cp\u003e20.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45241809672387%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e7.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.541341653666144%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e2000-2009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.068642745709827%\" valign=\"bottom\"\u003e\n \u003cp\u003e9.94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.976599063962558%\" valign=\"bottom\"\u003e\n \u003cp\u003e34.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45241809672387%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e7.23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e2.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.541341653666144%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2023\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.068642745709827%\" valign=\"bottom\"\u003e\n \u003cp\u003e9.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.976599063962558%\" valign=\"bottom\"\u003e\n \u003cp\u003e40.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.45241809672387%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.480499219968799%\" valign=\"bottom\"\u003e\n \u003cp\u003e3.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere were no statistically significant differences in terms of postoperative complications, mortality, and rate of early reinterventions between genders (p-value 0.9), nor according to the main cardiac diagnosis (p-value 0.4, 0.5, 0.5 respectively) (table 6), dominant ventricular morphology (p-value 0.7, 0.8, 0.4 respectively), or the presence of an additional ventricular chamber (p-value \u0026gt;0.9, 0.8, \u0026gt;0.9 respectively).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is of note that the onset of postoperative chylothorax was significantly associated with CHD with right ventricular dominance (FSRV) when compared to left ventricle dominance (p-value 0.03). Additionally, the presence of a surgical fenestration was associated with a higher incidence of percutaneous reinterventions (p-value 0.015), while non-fenestrated patients exhibited a greater tendency towards drainage duration exceeding 3 days (p-value 0.002) (table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eAnalysis of the associations between main cardiac diagnosis and the incidence in the main postoperative outcomes.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1095\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDouble inlet type (N=122)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft ventricular hypoplasia (N= 174)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiventricular type 1 (N= 256)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight ventricular hypoplasia (N= 283)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiventricular type 2 (N= 62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDouble inlet type vs left ventricular hypoplasia adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDouble inlet type vs Biventricular type 1 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft ventricular hypoplasia vs biventricular type 1 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDouble inlet type vs right ventricular hypoplasia adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft ventricular hypoplasia vs right ventricular hypoplasia adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiventricular type 1 vs right ventricular hypoplasia adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDouble inlet type vs Biventricular type 2 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft ventricular hypoplasia vs biventricular type 2 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiventricular type 1 vs Biventricular type 2 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u003cstrong\u003eright ventricular hypoplasia vs biventricular type 2 adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e51 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e78 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e131 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e127 (45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e23 (38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLCO syndrome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e3 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e6 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e6 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e2 (3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBradicardia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e11 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e12 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e5 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e4 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePleural effusion \u0026gt; 3 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e64 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e88 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e133 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e120 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e26 (84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e3 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e3 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e5 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e3 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly surgical reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e5 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e7 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e20 (7.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e20 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e5 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.132420091324201%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly catheter reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.3881278538812785%\"\u003e\n \u003cp\u003e4 (3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.7534246575342465%\"\u003e\n \u003cp\u003e4 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e8 (3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.301369863013699%\"\u003e\n \u003cp\u003e8 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e1 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.575342465753424%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.940639269406392%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.4840182648401825%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.931506849315069%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.210045662100456%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.666666666666667%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eAnalysis of the associations between some demographic\u0026rsquo;s features and the incidence in the main postoperative outcomes.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1090\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eComplication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLCO syndrome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\"\u003e\n \u003cp\u003e\u003cstrong\u003eArrythmias\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Bradi)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePleural effusion \u0026gt; 3 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly reintervention surgical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly reintervention catheter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly reintervention surgical + catheter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrenatal diagnosis:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (4%)\u003c/p\u003e\n \u003cp\u003e2 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (6.7%)\u003c/p\u003e\n \u003cp\u003e8 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105 (87%)\u003c/p\u003e\n \u003cp\u003e128 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (10%)\u003c/p\u003e\n \u003cp\u003e11 (5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (4.7%)\u003c/p\u003e\n \u003cp\u003e9 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20 (13%)\u003c/p\u003e\n \u003cp\u003e19 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDominant Ventricular Morphology:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLeft vs other\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLeft vs right\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eright vs other\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8 (1.7%) vs 1 (2.1%)\u003c/p\u003e\n \u003cp\u003e8 (1.7%) vs 6 \u0026nbsp;(1.6%)\u003c/p\u003e\n \u003cp\u003e6 (1.6%) vs 1 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.9\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;211 (45%) vs 24 (50%)\u003c/p\u003e\n \u003cp\u003e211 (45%) vs 175 (47%)\u003c/p\u003e\n \u003cp\u003e175 (47%) vs 24 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;0.7\u003c/p\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (1.9%) vs 3 (6.3%)\u003c/p\u003e\n \u003cp\u003e9 (1.9%) vs 5 (1.4%)\u003c/p\u003e\n \u003cp\u003e5 (1.4%) vs 3 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 0.08\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (2.5%) vs 3 (6.3%)\u003c/p\u003e\n \u003cp\u003e12 (2.5%) vs 18 (4.9%)\u003c/p\u003e\n \u003cp\u003e18 (4.9%) vs 3 (6.3%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.2\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e210 (78%) vs 34 (97%)\u003c/p\u003e\n \u003cp\u003e210 (78%) vs 187 (85%)\u003c/p\u003e\n \u003cp\u003e187 (85%) vs 34 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.022\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (6.5%) vs 5 (10%)\u003c/p\u003e\n \u003cp\u003e31 (6.5%) vs 21 (5.7%)\u003c/p\u003e\n \u003cp\u003e21 (5.7%) vs 5 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;11 (2.3%) vs 3 (6.3%)\u003c/p\u003e\n \u003cp\u003e11 (2.3%) vs 11 (3%)\u003c/p\u003e\n \u003cp\u003e11 (3%) vs 3 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 40 (8.4%) vs 7 (15%)\u003c/p\u003e\n \u003cp\u003e40 (8.4%) vs 31 (8.4%)\u003c/p\u003e\n \u003cp\u003e31 (8.4%) vs 7 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdditional ventricular chamber:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (1.5%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e299 (45%)\u003c/p\u003e\n \u003cp\u003e93 \u0026nbsp;(47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (1.6%)\u003c/p\u003e\n \u003cp\u003e4 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"bottom\"\u003e\n \u003cp\u003e24 (3.6%)\u003c/p\u003e\n \u003cp\u003e9 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e321 (81%)\u003c/p\u003e\n \u003cp\u003e95 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (6.5%)\u003c/p\u003e\n \u003cp\u003e13 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (3.1%)\u003c/p\u003e\n \u003cp\u003e4 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62 (9.2%)\u003c/p\u003e\n \u003cp\u003e16 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFenestration:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (1.6%)\u003c/p\u003e\n \u003cp\u003e8 (1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e196 (46%)\u003c/p\u003e\n \u003cp\u003e214 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (0.9%)\u003c/p\u003e\n \u003cp\u003e13 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"bottom\"\u003e\n \u003cp\u003e15 (3.5%)\u003c/p\u003e\n \u003cp\u003e18 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e199 (88%)\u003c/p\u003e\n \u003cp\u003e232 (77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (6.3%)\u003c/p\u003e\n \u003cp\u003e30 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (1.4%)\u003c/p\u003e\n \u003cp\u003e19 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;0.015\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 \u0026nbsp;(7.7%)\u003c/p\u003e\n \u003cp\u003e45 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Fontan:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt; 4 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt; 4 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (1.1%)\u003c/p\u003e\n \u003cp\u003e9 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.5688073394495414%\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.623853211009175%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e265 (50%)\u003c/p\u003e\n \u003cp\u003e145 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.293577981651376%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.889908256880734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (1.7%)\u003c/p\u003e\n \u003cp\u003e8 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.6605504587155964%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.26605504587156%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (3.6%)\u003c/p\u003e\n \u003cp\u003e14 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.7522935779816513%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.073394495412844%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e312 (86%)\u003c/p\u003e\n \u003cp\u003e119 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.2110091743119265%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.34862385321101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (5.2%)\u003c/p\u003e\n \u003cp\u003e29 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"2.8440366972477062%\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.981651376146789%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (3.9%)\u003c/p\u003e\n \u003cp\u003e4 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.761467889908257%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.037\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.256880733944953%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (8.4%)\u003c/p\u003e\n \u003cp\u003e33 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.853211009174312%\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWhen comparing ECC vs LT, in this series, the latter was associated with a greater incidence of LCO syndrome and early mortality (adj p-value 0.024 adj p-value 0.005) (table 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8:\u0026nbsp;\u003c/strong\u003eAnalysis of the associations between type of Fontan Operation and the incidence in the main postoperative outcomes.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1050\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKreutzer/Bjork (N= 12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatic vein to Azygos baffle (N= 5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCPC extracardiac conduit (N= 788)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCPC Lateral tunnel (N= 85)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKreutzer/Bjork vs Hepatic vein to azygos baffle adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKreutzer/Bjork vs TCPC extracardiac conduit adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatic vein to azygos baffle vs TCPC extracardiac conduit adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e\u003cstrong\u003eKreutzer/Bjork vs TCPC lateral tunnel adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHepatic vein to azygos baffle vs TCPC lateral tunnel adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCPC extracardiac conduit vs TCPC lateral tunnel adj p-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e9 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e5 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e345 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e48 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLCO syndrome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e11 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (5.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBradicardia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e1 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e29 (3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e3 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e9 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (5.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly surgical reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e1 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e52 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e4 (4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly catheter reintervention\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e22 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.904761904761905%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePleural effusion \u0026gt; 3 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.571428571428571%\"\u003e\n \u003cp\u003e6 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.095238095238095%\"\u003e\n \u003cp\u003e4 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.904761904761905%\"\u003e\n \u003cp\u003e\u003cstrong\u003e373 (86%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0476190476190474%\"\u003e\n \u003cp\u003e46 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.714285714285714%\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.142857142857142%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.523809523809524%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.809523809523809%\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.761904761904763%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOf note, we observed that age exceeding 4 years at Fontan completion was significantly correlated with a higher incidence of postoperative complications (p = 0.017), particularly concerning the requirement for early non-surgical reintervention (p = 0.037) and higher incidence of pleural drainage maintenance (p \u0026lt; 0.001) (Table 7). In conducting logistic regression analysis, with age treated as a continuous variable and adjusted for fenestration, age emerged as an independent risk factor for the composite outcome of postoperative complications, early reintervention, and early mortality. Specifically, with each additional year of age at the time of the Fontan procedure, the risk of experiencing all three outcomes increased by 7% (Table 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9:\u0026nbsp;\u003c/strong\u003eLogistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan and fenestration as covariates.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"415\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.301204819277107%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.542168674698797%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.46987951807229%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.301204819277107%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge at Fontan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.542168674698797%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.46987951807229%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.03-1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.301204819277107%\" valign=\"bottom\"\u003e\n \u003cp\u003eFenestration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.542168674698797%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.46987951807229%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.301204819277107%\" valign=\"bottom\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.542168674698797%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.46987951807229%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.301204819277107%\" valign=\"bottom\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.542168674698797%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.46987951807229%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.83-1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.686746987951807%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHowever, in regression analysis, when age was further adjusted for other variables (main cardiac diagnosis or type of Fontan surgery), the impact of age diminished when considering anatomical and surgical factors. This suggests that the tendency toward increased complications is more closely associated with underlying anatomical conditions rather than age at surgery (see Tables 10, 11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10:\u0026nbsp;\u003c/strong\u003eLogistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan, and type of Fontan operation as covariates.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"521\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge at Fontan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.97-1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eFenestration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.76-1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eType of Fontan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eAtrial-pulmonary connection (Kreutzer), Atrial-ventricular connection (Bjork)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eHepatic vein to azygous Baffle, Unknown/Not documented, other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e5,264,973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e0-inf\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026gt;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eTCPC Extracardiac conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.16-2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.882917466410746%\" valign=\"bottom\"\u003e\n \u003cp\u003eTCPC Lateral Tunnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.456813819577736%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.618042226487525%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.1-1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.042226487523994%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11:\u0026nbsp;\u003c/strong\u003eLogistic regression analysis with occurrence of postoperative complications as dependent variable and age at Fontan and main cardiac diagnosis as covariates.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"560\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eAge at Fontan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.97-1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eFenestration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.72-1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFundamental cardiac diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eDILV/DIRV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eHLHS, Hypoplastic left heart complex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.95-2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eTGA, DORV, DOLV, MA, Criss cross heart, Ebstein\u0026apos;s Anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.05-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eTA, Pulmonary PA-IVS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.87-2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.5%\" valign=\"bottom\"\u003e\n \u003cp\u003eUnbalanced CAVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.428571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.928571428571427%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.54-2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.142857142857142%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRegarding cardiac diagnosis, the median age at Fontan for each group of heart defects was calculated, revealing a statistically significant difference between the groups (adjusted p-value \u0026lt; 0.001). A boxplot illustrating the distribution of age at Fontan relative to the type of cardiac diagnosis is presented (Fig. 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLast, as anticipated, the majority of patients (66%) undergoing the LT had a median age of while 62% of median age of patients undergoing the ECC was significantly higher than those who had LT (4.6 years \u0026nbsp;-IQ 3.4-6.5, versus \u0026nbsp;3.5 -IQ 2.5 \u0026ndash; 5, adjusted p-value \u0026lt; 0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFontan palliation has emerged as a standard procedure for patients with FSV. Since its inception (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), there have been significant improvement in the early outcomes of Fontan circulation. The mortality rate, once high in the 1980s (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), have decreased to approximately 2\u0026ndash;4%, according to data from the ECHSA congenital database (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://echsacongenitaldb.org\u003c/span\u003e\u003cspan address=\"https://echsacongenitaldb.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e and other previously cited reports (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Over the past thirty years, the original Fontan surgical technique has undergone various modifications, evolving from the initial techniques proposed by Bjork and Kreutzer (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) to the refined methodology introduced by Marcelletti (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In our study population, the ECC has emerged as the preferred surgical approach (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Graph 1), followed by the LT (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), particularly in younger pediatric patients, as it avoids the use of small conduits which may cause a need for a late reoperation for conduit replacement.\u003c/p\u003e \u003cp\u003eIt appears that despite the use of diverse surgical techniques (namely ECC vs LT), there was not a significant difference in the occurrence of early complications overall. However, it's noteworthy that LT has shown a stronger association with the onset of LCO syndrome and early mortality compared to ECC. This difference in outcomes may be influenced by various factors (such as the patients\u0026rsquo; BSA and age at operation, need to operate earlier). Additionally, in other studies comparing the LT vs ECC procedures, the former has been linked to higher rates of postoperative complications, particularly arrhythmias. This suggests that the choice of surgical approach may have implications for patient outcomes and warrants careful consideration in clinical decision-making (\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin our study population, there has been a remarkable and continuous reduction in mortality, with an overall mortality rate of 1.7%, and an evident dropping from 3.31% in the 1990s to 1.35% more recently (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, graph 2). This trend is further highlighted when examining the data by decades, revealing a consistent decrease in mortality rates over time. This decline can be attributed to advancements in surgical techniques, improvements in preoperative patient selection, and enhancements in postoperative management protocols. Conversely, there has been a notable increase in overall complications, impacting a substantial portion of our cohort (46%). This trend aligns with previous findings reported in 2012, where a large multicenter study involving 2747 patients undergoing TCPC with lateral tunnel (LT) versus extracardiac conduit (ECC) in the USA documented a complication rate of 40.4% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, upon scrutinizing these complications, it becomes evident that minor complications and the need for non-surgical reintervention have escalated (from 20.7\u0026ndash;40.5%, from 0\u0026ndash;3.83% respectively), juxtaposed with a reduction in total major complications (from 11.6\u0026ndash;9.46%) and surgical need of reintervention (from 7.44\u0026ndash;5.41%) (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, graph 2). This trend through decades in mortality and incidence of complications mirrors the one observed in other scientific studies. In an Italian report published in the 90s, the rate of early mortality was 10%, of early Fontan failure was 15%, of Fontan takedown was 10%, and of overall surgical reintervention was 16.6% (Fontan takedown, stenotic anastomosis, plication of hemidiaphragm) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In contrast, in a more recent and previously cited study, released in 2012, the researchers analyzed 2747 Fontan patients and the in-hospital mortality turned out to be 1.6% with a Fontan takedown/revision rate of 1.4% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePersistent pleural effusions and prolonged chest tube stay are well known postoperative complications after Fontan (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In our series, the median duration of chest tube placement was 7 days, consistent with findings reported by others (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Also, 241 (89.6% of those requiring prolonged chest tube stay) had their chest tubes in place for more than 7 days. This extended timeframe confirms the persistent nature of the postoperative effusion issue, potentially influenced also by the prevalent practice of prolonged chest tube insertion in Fontan patients, who have a known propensity for effusion. Notably, a higher percentage of non-fenestrated patients had prolonged chest tube retention compared to fenestrated patients (88% vs. 77%; p-value 0.019). This finding underscores the potential impact of fenestration on postoperative drainage management in Fontan patients. Further data analyses are necessary to delve deeper into this observation and understand its implications fully.\u003c/p\u003e \u003cp\u003eNotably, when assessing the clinical impact of ventricular dominance on early outcomes, we did not find any statistically significant differences in the occurrence of major adverse events, other than a higher incidence of chylothorax in patients with right ventricular dominance (5.7% vs 2.5%; p-value 0.03). Recent findings by Ponzoni et al. suggested that Fontan patients with a right-dominant ventricle exhibit inferior long-term survival, especially when the anatomical right ventricle is part of the systemic circulation (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Also, Pollak et al (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) highlighted prolonged postoperative hospitalization, along with poorer early postoperative indicators (ventricular dysfunction and atrioventricular valve regurgitation), in patients with right ventricular morphology compared to those with left ventricular morphology. A study by Ovroutski et al. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) suggested right ventricle morphology as a risk factor for early Fontan failure. Our observations suggest that the early postoperative course following the Fontan operation may be influenced by the effective systolic and diastolic function of the ventricular chamber, regardless of its morphology.\u003c/p\u003e \u003cp\u003eOne noteworthy finding from our research pertains to the age at Fontan completion. Presently, there exists no consensus among clinicians or surgeons regarding the optimal timing of Fontan completion. Some studies have reported no statistically significant differences in early outcomes, morbidity, or mortality based on age (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Other reports showed that an age of approximately 4 years or younger, at the time of Fontan completion, is associated with better outcomes, both in the short and long term (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). In contrast, higher age has been associated with the need for revision surgery, and late death (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Fontan failure, a decline in exercise capacity, and a reduction in cardiac index (\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In a study of 3319 patients, published by Akintoye et al. in 2018, the age of 3 years was identified as the optimum for Fontan completion, as evidenced by a lower rate of in-hospital mortality, procedure‐related complications, and rate of nonroutine home discharge (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). However, a study by Pace Napoleone et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), affirmed that the modified Fontan operation can be performed safely in older patients without affecting operative and medium-term follow-up results. They divided their cohort into two groups according to the age of 7 years old at the time of Fontan completion. Mortality (respectively 0% in group\u0026thinsp;\u0026lt;\u0026thinsp;7 years, 5.4% in group\u0026thinsp;\u0026gt;\u0026thinsp;7 years; p\u0026thinsp;=\u0026thinsp;0.5) and complications were similar between the two groups. As D\u0026rsquo;Udekem et al reported (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), the \u0026lsquo;ticking clock theory\u0026rsquo; advocates that any Fontan circulation will have a limited lifetime so the decision regarding the age at which to perform the Fontan procedure is challenging. Delaying the intervention poses a high risk of paradoxical embolism and side effects associated with chronic cyanosis. On the other hand, performing the procedure early entails a heightened risk of elevated pulmonary resistance, systemic venous hypertension, arrhythmias, and low oxygen saturation. In our cohort of Fontan patients, the median age was 4 years, which we used as a cutoff to divide our cohort. Upon analyzing the overall incidence of complications, we observed that patients older than 4 years exhibited a higher occurrence of poor early outcomes compared to those younger than 4 years (50% vs 40%; adjusted p-value 0.017). We also noted a correlation with percutaneous reinterventions (3.9% vs 1.1%; adjusted p-value 0.037) and drainage duration exceeding 3 days (86% vs 72%; adjusted p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Our logistic regression analysis, which included age as a continuous variable and was adjusted for fenestration, identified age as an independent relative risk factor. Specifically, for each additional year at the time of Fontan operation, there was a 7% increase in the risk of encountering complications. However, upon additional adjustment for other variables such as main cardiac diagnosis or type of Fontan operation, the significance of age as a risk factor diminished. This suggests that despite younger age seems to be a protective factor for early outcomes, the impact of age on complication risk may be also influenced by the specific procedural approach utilized and the underlying cardiac pathology, rather than age itself being an inherent risk factor.\u003c/p\u003e\n\u003ch3\u003eStudy limitations\u003c/h3\u003e\n\u003cp\u003eAs a retrospective multicenter study, there may have been selection bias; however, we endeavored to mitigate this bias by including centers with varying Fontan completion volumes and encompassing all Fontan procedures at each center. While we have comprehensive preoperative and operative data on all enrolled patients, disparities in postoperative ICU time and missing data could have impacted our results. Additionally, due to the extensive time frame covered by our cohort, the loss of certain anatomical details and perioperative data was unavoidable and may have influenced our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe perioperative outcomes of the Fontan procedure have shown a consistent and notable improvement over the past thirty years in Italy. Mortality rates have steadily decreased from 3.31\u0026ndash;1.35% across the decades. Among the various surgical techniques utilized, the ECC method has emerged as both the most frequently employed and the safest option, associated with fewer postoperative complications compared to alternative approaches. However, our analysis has revealed that age exceeding 4 years at the time of Fontan completion may represent a significant risk factor for the development of complications, reinterventions, and early mortality. This emphasizes the critical role of considering patient age as a pivotal factor in the planning and execution of the Fontan procedure. By carefully considering age in surgical decision-making, healthcare professionals can strive for optimal outcomes and mitigate potential risks associated with Fontan surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eI.C. and E.B. Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Software; Visualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editingM.P. Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; review \u0026amp; editingL.V. Formal analysis; Methodology; Software; ValidationG.G. Data Curation; review \u0026amp; editingV.L.V. Supervision; ValidationA.G. Validation; review \u0026amp; editingL.G., G.B., M.T., M.P., G.D.G, E.A., L.C., R.Z., C.P.N, L.D.O., F.S., A.G., M.L., S.M.M., S.A., E.B., U.V., G.M., G.S., G.S., H.N., G.M., R.B., A.G., G.D. Data curation; Investigation; All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it\u0026nbsp;for\u0026nbsp;publication.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData that support the findings of this study have been collected and deposited in https://research.dctv.unipd.it/redcap/Data are protected with user and password and avaiable through reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26(3):240\u0026ndash;248\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoh C, Hornung T, Celermajer DS, Radford DJ, Justo RN, Andrews D et al (2020) Modes of late mortality in patients with a Fontan circulation. Heart 106(18):1427\u0026ndash;1431\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTweddell JS, Nersesian M, Mussatto KA, Nugent M, Simpson P, Mitchell ME et al (2009) Fontan Palliation in the Modern Era: Factors Impacting Mortality and Morbidity. Ann Thorac Surg 88(4):1291\u0026ndash;1299\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogers LS, Glatz AC, Ravishankar C, Spray TL, Nicolson SC, Rychik J et al (2012) 18 years of the Fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol 60(11):1018\u0026ndash;1025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHjortdal VE (2022) The Fontan operation: when and why? Eur J Cardiothorac Surg 61(3):495\u0026ndash;496\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossi E, Frigo AC, Reffo E, Cabrelle G, Castaldi B, Di Salvo G et al (2021) The presence of an additional ventricular chamber does not change the outcome of Fontan circulation: a comparative study. Eur J Cardiothorac Surg 60(5):1074\u0026ndash;1081\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26(3):240\u0026ndash;248\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCetta F, Feldt RH, O\u0026rsquo;Leary PW, Mair DD, Warnes CA, Driscoll DJ et al (1996) Improved early morbidity and mortality after Fontan operation: the Mayo Clinic experience, 1987 to 1992. J Am Coll Cardiol 28(2):480\u0026ndash;486\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKverneland LS, Kramer P, Ovroutski S (2018) Five decades of the Fontan operation: A systematic review of international reports on outcomes after univentricular palliation. Congenit Heart Dis 13(2):181\u0026ndash;193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBj\u0026ouml;rk VO, Olin CL, Bjarke BB, Thor\u0026eacute;n CA (1979) Right atrial-right ventricular anastomosis for correction of tricuspid atresia. J Thorac Cardiovasc Surg 77(3):452\u0026ndash;458\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKreutzer G, Gal\u0026iacute;ndez E, Bono H, De Palma C, Laura JP (1973) An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 66(4):613\u0026ndash;621\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarcelletti C, Corno A, Giannico S, Marino B (1990) Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg 100(2):228\u0026ndash;232\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuga FJ, Chiavarelli M, Hagler DJ (1987) Modifications of the Fontan operation applicable to patients with left atrioventricular valve atresia or single atrioventricular valve. Circulation 76(3 Pt 2):III53\u0026ndash;60\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJonas RA, Castaneda AR (1988) Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastomotic techniques. J Card Surg 3(2):91\u0026ndash;96\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Leval MR, Kilner P, Gewillig M, Bull C (1988) Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 96(5):682\u0026ndash;695\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JR, Kwak J, Kim KC, Min SK, Kim WH, Kim YJ et al (2007) Comparison of lateral tunnel and extracardiac conduit Fontan procedure. Interact Cardiovasc Thorac Surg 6(3):328\u0026ndash;330\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzakie A, McCrindle BW, Van Arsdell G, Benson LN, Coles J, Hamilton R et al (2001) Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 122(6):1219\u0026ndash;1228\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng J, Li Z, Li Q, Li X (2018) Meta-analysis of Fontan procedure: Extracardiac conduit vs. intracardiac lateral tunnel. Herz 43(3):238\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBacker CL, Deal BJ, Kaushal S, Russell HM, Tsao S, Mavroudis C (2011) Extracardiac versus intra-atrial lateral tunnel fontan: extracardiac is better. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 14(1):4\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePundi KN, Johnson JN, Dearani JA, Pundi KN, Li Z, Hinck CA et al (2015) 40-Year Follow-Up After the Fontan Operation: Long-Term Outcomes of 1,052 Patients. J Am Coll Cardiol 66(15):1700\u0026ndash;1710\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStewart RD, Pasquali SK, Jacobs JP, Benjamin DK, Jaggers J, Cheng J et al (2012) Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection. Ann Thorac Surg 93(4):1254\u0026ndash;1260 discussion 1261\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallace MC, Jaggers J, Li JS, Jacobs ML, Jacobs JP, Benjamin DK et al (2011) Center variation in patient age and weight at Fontan operation and impact on postoperative outcomes. Ann Thorac Surg 91(5):1445\u0026ndash;1452\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmodeo A, Galletti L, Marianeschi S, Picardo S, Giannico S, Di Renzi P et al (1997) Extracardiac Fontan operation for complex cardiac anomalies: seven years\u0026rsquo; experience. J Thorac Cardiovasc Surg 114(6):1020\u0026ndash;1030 discussion 1030\u0026ndash;1031\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonzoni M, Azzolina D, Vedovelli L, Gregori D, Di Salvo G, D\u0026rsquo;Udekem Y et al (2022) Ventricular morphology of single-ventricle hearts has a significant impact on outcomes after Fontan palliation: a meta-analysis. Eur J Cardiothorac Surg 62(6):ezac535\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePollak U, Abarbanel I, Salem Y, Serraf AE, Mishaly D (2022) Dominant Ventricular Morphology and Early Postoperative Course After the Fontan Procedure. World J Pediatr Congenit Heart Surg 13(3):346\u0026ndash;352\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOvroutski S, Sohn C, Barikbin P, Miera O, Alexi-Meskishvili V, H\u0026uuml;bler M et al (2013) Analysis of the risk factors for early failure after extracardiac Fontan operation. Ann Thorac Surg 95(4):1409\u0026ndash;1416\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePizarro C, Mroczek T, Gidding SS, Murphy JD, Norwood WI (2006) Fontan completion in infants. Ann Thorac Surg 81(6):2243\u0026ndash;2248 discussion 2248\u0026ndash;2249\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhimire LV, Chou FS, Pundi K, Moon-Grady AJ (2022) In-Hospital Outcomes in Fontan Completion Surgery According to Age. Am J Cardiol 166:81\u0026ndash;87\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkintoye E, Veldtman GR, Miranda WR, Connolly HM, Egbe AC (2019) Optimum age for performing Fontan operation in patients with univentricular heart. Congenit Heart Dis 14(2):138\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlphonso N, Baghai M, Sundar P, Tulloh R, Austin C, Anderson D (2005) Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis. Eur J Cardiothorac Surg 28(4):529\u0026ndash;535\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsdick V, Iyengar AJ, Carins T, Gentles TL, Weintraub RG, Celermajer DS et al (2015) Unsatisfactory Early and Late Outcomes After Fontan Surgery Delayed to Adolescence and Adulthood. Semin Thorac Cardiovasc Surg 27(2):168\u0026ndash;174\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ed\u0026rsquo;Udekem Y, Iyengar AJ, Galati JC, Forsdick V, Weintraub RG, Wheaton GR et al (2014) Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation 130(11 Suppl 1):S32\u0026ndash;38\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOvroutski S, Ewert P, Miera O, Alexi-Meskishvili V, Peters B, Hetzer R et al (2010) Long-term cardiopulmonary exercise capacity after modified Fontan operation. Eur J Cardiothorac Surg 37(1):204\u0026ndash;209\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiraishi S, Yagihara T, Kagisaki K, Hagino I, Ohuchi H, Kobayashi J et al (2009) Impact of age at Fontan completion on postoperative hemodynamics and long-term aerobic exercise capacity in patients with dominant left ventricle. Ann Thorac Surg 87(2):555\u0026ndash;560 discussion 560\u0026ndash;561\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePace Napoleone C, Oppido G, Angeli E, Giardini A, Resciniti E, Gargiulo G (2010) Results of the modified Fontan procedure are not related to age at operation. Eur J Cardiothorac Surg 37(3):645\u0026ndash;650\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ed\u0026rsquo;Udekem Y, Xu MY, Konstantinov IE (2011) The optimal age at Fontan procedure and the \u0026lsquo;ticking clock\u0026rsquo; theory: do we have an answer? Eur J Cardiothorac Surg. ;39(1):144; author reply 144\u0026ndash;145\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Graph","content":"\u003cp\u003eGraph 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-cardiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pedc","sideBox":"Learn more about [Pediatric Cardiology](http://link.springer.com/journal/246)","snPcode":"246","submissionUrl":"https://submission.nature.com/new-submission/246/3","title":"Pediatric Cardiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"single ventricle, Fontan, operative survival, surgical palliation, early outcomes, univentricular heart","lastPublishedDoi":"10.21203/rs.3.rs-4283962/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4283962/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDespite the clinical results of the Fontan operation have certainly improved, it still presents with an inherent surgical risk of death and early morbidities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis is a\u003cstrong\u003e \u003c/strong\u003eretrospective clinical study of children undergoing Fontan operation in 9 congenital cardiac centers in Italy between 1990 and 2023. Clinical and surgical data were collected via a dedicated RedCap database.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u0026nbsp;In the last 3 decades, there were 897 patients undergoing Fontan operation, M/F 512/384, median age: 4.5 years (IQR 3.3 -6.4), median weight 16 kg (IQR 14-22). A first palliation was deemed necessary in 710 patients (80%), and most patients underwent a staged Fontan (93%); an extracardiac conduit was used in 790 patients (88%). Postoperative complications (mild to severe) occurred in 410 patients (46%), and early reinterventions were required in 66 patients (7.5%). Overall operative mortality was 1.7% (15 patients). Age at Fontan greater than 4 years was associated with an early need for transcatheter reintervention (adj p-value=0.037) and a higher incidence of postoperative complications (adj p-value=0.017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The Fontan operation has seen significant improvements in immediate outcomes, notably a remarkable reduction in overall mortality to just 1.35% in the last decade. While minor complications have remained steady, there has been a substantial decrease in major early complications, deaths, and the need for reinterventions. Notably, patients aged over 4 years seem to face a higher risk of postoperative morbidity, underscoring the critical role of age in preoperative assessment and management strategies for Fontan patients.\u003c/p\u003e","manuscriptTitle":"Postoperative Outcomes of Fontan Operation in a Multicenter Italian Study. 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