Perfil clínico e cirúrgico dos pacientes da Cirurgia de Fontan em um Centro de Referência no Brasil

Abstract

Introduction: The Fontan surgery, the final stage of univentricular physiology, was initially described in 1968 and has changed the perspective and quality of life for patients. Over the years, surgical techniques have been refined. Currently, the most common techniques include the lateral tunnel and the extracardiac conduit, which may be fenestrated with an opening in the right atrium or not. Despite the challenges of the surgery, with a wide range of potential complications, many patients undergoing Fontan surgery can lead active and healthy lives, with significantly improved quality of life compared to their pre-operative condition. Objective: To evaluate and describe the clinical and epidemiological profile of patients, between 3 and 18 years of age, with congenital heart disease, who underwent Fontan surgery at a tertiary reference pediatric cardiology hospital in Salvador. Method: A cross-sectional and retrospective study, based on the analysis of medical records of patients aged 3 to 18 years with congenital heart disease, who underwent Fontan surgery between January 2015 and December 2023 at a tertiary pediatric cardiology unit in Salvador, Bahia. Data collection was conducted through the completion of forms based on the review of medical records, including the following variables: sex, age range, origin, underlying heart disease, age at the time of surgery, immediate and late postoperative complications, and mortality rate.Results: The final sample consisted of 29 patients. Male patients predominated (55%), with an average age at surgery of 7.45 years, mostly from the metropolitan area of Salvador (27%). The most prevalent defect was Tricuspid Atresia, with type 1B affecting 8 patients (34.8%), type 1C affecting 3 patients (10.3%), and type 1A affecting 2 patients (6.9%). A total of 9 patients died, representing approximately 31% of the studied population, with 8 deaths occurring in the immediate postoperative period. Conclusion: The median age with interquartile range of the patients was 4 years at the time of the surgical procedure, still within the ideal period for Fontan surgery. The mortality rate remains high, which is consistent with data from other studies.