{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T09:12:04Z","timestamp":1768036324249,"version":"3.49.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,10,23]],"date-time":"2021-10-23T00:00:00Z","timestamp":1634947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Fontan patients are known to suffer from clinical attrition over the years, which has been characterized as Fontan failure. We sought to evaluate the clinical outcomes of such Fontan patients undergoing surgical management in a 25-year, single-centre experience.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>A retrospective single-centre analysis of patients undergoing surgical treatment for failing Fontan between 1995 and 2020, including any reoperations when ventricular function was preserved, or a heart transplant (HTx), when ventricular contractility was impaired. We analysed survival, indications for surgery and early and late complication rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>We collected 30 patients (mean age 24.7\u2009years) who required surgery after a mean time of 19.3\u2009years from the original Fontan procedure: Fontan conversion in 21 (70%, extracardiac conduit in 19, lateral tunnel in 2), a HTx in 4 (13.3%) and other reoperations in 5 (16.7%). The most common indications for surgery were tachyarrhythmias (63.3%) and severe right atrial dilatation (63.3%). Overall survival at the 1-, 5-, 10- and 20-year follow-up examinations were 75.9% [95% confidence interval (CI): 91.4\u201360.4%], 75.9% (95% CI: 91.4\u201360.4%), 70% (95% CI: 78\u201352%) and 70% (95% CI: 78\u201352%), respectively. The most frequent complications were postoperative tachyarrhythmias (50%) and late Fontan-associated liver disease (56.5%). HTx and Fontan conversion provided comparably good outcomes compared to other reoperations (P\u2009=\u20090.022).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Surgery for failing Fontan can be performed effectively with overall good long-term survival. However, early and late morbidities are still a significant burden. Because other reoperations performed when patients presented with contraindications for a HTx have carried high mortality, close clinical follow-up is mandatory, and an earlier indication for Fontan conversion or a HTx is advisable to optimize outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab450","type":"journal-article","created":{"date-parts":[[2021,10,16]],"date-time":"2021-10-16T03:36:40Z","timestamp":1634355400000},"page":"338-345","source":"Crossref","is-referenced-by-count":12,"title":["Surgical management of failing Fontan circulation: results from 30 cases with 285 patient-years follow-up"],"prefix":"10.1093","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7535-9670","authenticated-orcid":false,"given":"Massimo A","family":"Padalino","sequence":"first","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Ponzoni","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biagio","family":"Castaldi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Woman and Child\u2019s Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loira","family":"Leoni","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Chemello","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine-DIMED, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Toscano","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-699X","authenticated-orcid":false,"given":"Gino","family":"Gerosa","sequence":"additional","affiliation":[{"name":"Cardiac Surgery and Heart Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Woman and Child\u2019s Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimiro L","family":"Vida","sequence":"additional","affiliation":[{"name":"Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,10,23]]},"reference":[{"key":"2022012513094042400_ezab450-B1","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1136\/heartjnl-2011-301133","article-title":"Management of the failing Fontan 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