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Outcomes Of Aortic Intervention After Cavopulmonary Palliation
Eishan Ashwat, MD, Elizabeth H. Stephens, MD, PhD, Nathan W. Taggart, MD, Alberto Pochettino, MD, Joseph A. Dearani, MD.
Mayo Clinic, Rochester, MN, USA.
Objectives: Data on aortic surgery in patients with cavopulmonary physiology are limited. We describe a single-center longitudinal experience with aortic root and arch operations in patients with Glenn or Fontan circulation.
Methods: We retrospectively reviewed patients with cavopulmonary physiology who underwent aortic root or arch intervention during or after a bidirectional Glenn or Fontan operation from 1999 to 2025.
Results: Eight patients met inclusion criteria. Aortic intervention occurred as late as 34 years after Fontan completion (median, 9.7 years). Five patients (62.5%) underwent isolated arch repair, two (25.0%) underwent aortic root replacement (one mechanical valve, one homograft), and one (12.5%) underwent combined root replacement with total arch reconstruction. Three interventions (37.5%) were performed after bidirectional Glenn and five (62.5%) after Fontan completion. Indications included root/arch aneurysm (n = 5, 62.5%) and residual arch obstruction (n = 3, 37.5%). No early postoperative deaths occurred. Median hospital length of stay was 13 days with a median ICU stay of 4.5 days. By last follow-up, two patients had died: one of suspected aortic dissection and one of unknown cause. Among survivors, median post-intervention follow-up was 3.3 years.
Conclusions: Aortic intervention after Fontan circulation is uncommon but may be required years after cavopulmonary palliation. In this small cohort, early outcomes were favorable and repairs were generally durable, but optimal timing of intervention remains uncertain.
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