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The Fontan Kreutzer procedure is used in pediatric patients who possess only a single functional ventricle, either due to lack of a heart valve (e.g. tricuspid or mitral atresia), an abnormality of the pumping ability of the heart (e.g. hypoplastic left heart syndrome or hypoplastic right heart syndrome), or a complex congenital heart disease where a bi-ventricular repair is impossible or ...
The last surgery, known as the Fontan procedure, is typically performed around the age of 18 months and older. The final result of these surgeries is to redirect the superior and inferior vena cavae into the pulmonary artery, bypassing the right atrium.
Currently, infants undergo either the staged reconstructive surgery (Norwood or Sano procedure within a few days of birth, Glenn or Hemi-Fontan procedure at 3 to 6 months of age, and the Fontan procedure at 1 1/2 to 5 years of age) or cardiac transplantation. [10] Current expectations are that 70% of those with HLHS may reach adulthood. [18]
An estimated annual 1,000 Fontan procedures are performed annually in the United States, with an estimated 50,000 to 70,000 patients having completed the procedure as of 2018. [ 14 ] [ 15 ] In Europe, an estimated 25,000 patients have completed the Fontan procedure as of 2021.
Long-term survival rates for children with single ventricle physiology are improving as medical and surgical advancements continue. In the major SVR trial (Single Ventricle Reconstruction) the transplant-free survival rate was only 54-59% amongst patients who underwent the Norwood procedure. [32]
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[32] [33] Advantages of mitral valve repair over replacement include lower surgical mortality (~1% for repair vs ~5% for replacement [34]), lower rates of stroke and endocarditis (an infection of the heart’s inner lining), equivalent or better long‑term durability, [35] [36] [37] and improved long-term survival. [35]
The rate of certified doctors looking to treat up to the maximum 100 patients has slowed. When the federal government began allowing physicians to treat more than 30 patients in 2007, nearly 2,000 doctors applied, according to data from the Substance Abuse and Mental Health Services Administration.