{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:09:22Z","timestamp":1792681762143,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,10,1]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>National prevalence and outcomes of Fontan operation in the USA is unknown. Study objective was to determine trends (temporal change) in the annual volume of Fontan operations, in-hospital mortality, postoperative complications and type of hospital discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Review of the Nationwide Inpatient Sample for patients that underwent Fontan operation from 2001 to 2014 using the International Classification of Diseases-Ninth Revision, Clinical Modification procedure code for Fontan operation, that is, 35.94. To evaluate for change in patients\u2019 demographics over the years, we divided the patient population into four groups based on procedure year (2001\u20132004, 2005\u20132008, 2009\u20132011 and 2012\u20132014).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>An estimated 15 934 Fontan operations were performed in the USA from 2001 to 2014. Median (Q1\u2013Q3) age was 3 (2\u20134) years and 39.8% were female. Hypoplastic left heart syndrome was the most common (29%) congenital heart disease diagnosis. An estimated 1175 procedures were performed in 2001 and 1340 in 2014, but there was no significant change in the number of procedures per year (p=0.47). There was significant decline in in-hospital mortality from 4.5% (53\/1175) in 2001 to 1.1% (15\/1340) in 2014 (p=0.009). When we compared event rates between 2001\u20132004 and 2012\u20132014 periods, there was significant decline in postoperative cardiac complications (12.6% (459\/3640) to 8% (378\/4706), p=0.007) and respiratory complications (17.1% (623\/3640) to 10.2% (481\/4706), p&lt;0.001). However, there was increase in the number of patients discharged to home with healthcare assistance or transferred to another acute care facility (5.8% (211\/3640) to 9.4% (443\/4706), p=0.01) and inflation-adjusted hospitalisation cost (US$46\u2009978 to US$60 383, p&lt;0.001), but no significant change in length of stay (p=0.73).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>On the average, 1062 Fontan operations are performed annually in the USA with no change in volume of procedures but a decrease in in-hospital mortality and postoperative complications over a 15-year period.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313680","type":"journal-article","created":{"date-parts":[[2018,10,30]],"date-time":"2018-10-30T12:15:43Z","timestamp":1540901743000},"page":"708-714","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":52,"title":["National trends in Fontan operation and in-hospital outcomes in the USA"],"prefix":"10.1136","volume":"105","author":[{"given":"Emmanuel","family":"Akintoye","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Wayne State University\/Detroit Medical Center, Detroit, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Miranda","sequence":"additional","affiliation":[{"name":"Depertment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gruschen R","family":"Veldtman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi M","family":"Connolly","sequence":"additional","affiliation":[{"name":"Depertment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander C","family":"Egbe","sequence":"additional","affiliation":[{"name":"Depertment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,10,30]]},"reference":[{"key":"2025092015140081000_105.9.708.1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307467"},{"key":"2025092015140081000_105.9.708.2","doi-asserted-by":"publisher","DOI":"10.1136\/thx.26.3.240"},{"key":"2025092015140081000_105.9.708.3","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.117.004515","article-title":"Hemodynamics of Fontan Failure: The Role of Pulmonary Vascular Disease","volume":"10","author":"Egbe","year":"2017","journal-title":"Circ Heart Fail"},{"key":"2025092015140081000_105.9.708.4","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ahj.2016.12.015","article-title":"Outcomes in adult Fontan patients with atrial tachyarrhythmias","volume":"186","author":"Egbe","year":"2017","journal-title":"Am Heart J"},{"key":"2025092015140081000_105.9.708.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.06.056"},{"key":"2025092015140081000_105.9.708.6","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ijcard.2018.01.108","article-title":"Temporal changes in liver stiffness after Fontan operation: Results of serial magnetic resonance elastography","volume":"258","author":"Egbe","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025092015140081000_105.9.708.7","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.jtcvs.2016.10.060","article-title":"Liver health in adults with Fontan circulation: a multicenter cross-sectional study","volume":"153","author":"Wu","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025092015140081000_105.9.708.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.04.025"},{"key":"2025092015140081000_105.9.708.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.07.065"},{"key":"2025092015140081000_105.9.708.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.09.074"},{"key":"2025092015140081000_105.9.708.11","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/S0022-5223(19)35174-8","article-title":"Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. 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