Journal of Angiotherapy
Angiogenesis, Inflammation & Therapeutics | Online ISSN  2207-872X
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Contents Vol 8 (11)

Impact of Fenestration on Outcomes of the Fontan Procedure: A Systematic Review and Meta-Analysis

Prima Abdillah Akbar 1*, Arief Rakhman Hakim 2

+ Author Affiliations

Journal of Angiotherapy 8 (11) 1-8 https://doi.org/10.25163/angiotherapy.81110050

Submitted: 11 September 2024 Revised: 16 November 2024  Published: 17 November 2024 

Abstract

Background: The Fontan procedure remains the definitive surgical intervention for single-ventricle congenital heart defects. The effectiveness of fenestration in the Fontan procedure has been debated, with numerous studies reporting inconsistent outcomes. However, its routine implementation remains controversial, with studies presenting conflicting results regarding its clinical efficacy and associated complications. Methods: A systematic review and meta-analysis were conducted in adherence to the PRISMA guidelines. A comprehensive literature search was performed across PubMed, ScienceDirect, and ResearchGate for studies published between 1992 and 2022. Inclusion criteria encompassed clinical trials comparing fenestrated and non-fenestrated Fontan procedures and reporting outcomes such as cardiopulmonary bypass (CPB) time, oxygen saturation, ICU stay, hospital length of stay, pleural effusion, Fontan failure, survival, and mortality. A total of 16 studies involving 6,282 participants were included. Statistical analysis was performed using Review Manager 5.4.1, and pooled effect sizes were presented using odds ratios (OR) or mean differences (MD), with heterogeneity assessed using the I² statistic. Results: The meta-analysis revealed a significant reduction in CPB time in the fenestrated group (MD, 12.66; 95% CI, [2.87, 22.46]; p = 0.01; I² = 36%). Oxygen saturation was significantly lower postoperatively in fenestrated patients (MD, -3.46; 95% CI, [-5.96, -0.96]; p = 0.007; I² = 89%). Prolonged pleural effusion was less frequent in the fenestrated group (OR, 0.47; 95% CI, [0.24, 0.93]; p = 0.03; I² = 84%). However, no significant differences were observed in ICU stay, hospital length of stay, Fontan failure, survival rate, or mortality between the groups. Conclusion: While fenestration in the Fontan procedure demonstrates certain hemodynamic benefits, such as reduced pleural effusion and CPB time, it is associated with postoperative desaturation and does not significantly impact critical outcomes like survival or Fontan failure. These findings underscore the importance of individualized patient selection for fenestration to balance its benefits against potential risks. Further research is warranted to refine the criteria for fenestration use in the Fontan procedure.

Keywords: Fontan procedure, fenestration, congenital heart defects, surgical outcomes, meta-analysis

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