Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective The Fontan procedure is a crucial surgical intervention for single-ventricle physiology, with the extracardiac conduit (ECC) and lateral tunnel (LT) techniques being the predominant approaches. This study aimed to compare early and late clinical outcomes of ECC and LT, using inverse probability of treatment weighting (IPTW) to ensure robust assessments. Methods A retrospective analysis of 3300 patients from the EUROFONTAN registry was conducted, with data collected from 21 European centers. The cohort included 3010 patients who underwent the ECC technique and 290 patients who underwent the LT technique. IPTW was used to balance baseline characteristics. Primary outcomes were early and late mortality, Fontan failure, and adverse events. Secondary outcomes included postoperative complications and nonsurgical adverse events. Results Propensity-matched analysis showed significantly better outcomes for ECC. Early mortality was lower for ECC (1.2% vs 3.9%, P = .003), whereas late mortality at 20-year follow-up was 8.6% in LT versus 3.2% in ECC after IPTW ( P = .003). Patients who underwent the ECC technique experienced fewer postoperative complications (47% vs 66%, P = .025) and less frequent Fontan failure (12% vs 19%, P = .032). Kidney-related events were more frequent in patients who underwent the LT technique (3% vs 0.6%, P = .004). The development of arrhythmia initially appeared greater in the LT group but equalized after matching. Long-term complications, such as protein-losing enteropathy and hepatic issues, showed no significant differences. Conclusions ECC was associated with better early and intermediate outcomes than LT in this multicenter European registry. However, surgical era and hospital center explain a substantial part of the observed difference. Continued long-term surveillance of the Fontan pathway is essential to optimize lifelong outcomes.
Source: JTCVS Open
Authors: Emma Bergonzoni, Irene Cao, Luca Vedovelli, Mark Hazekamp, Jürgen Hörer, Eleftherios M. Protopapas, Masamichi Ono, Eva Sames-Dolzer, Gregor Gierlinger, Friso M. Rijnberg, Lorenzo Galletti, Gianfranco Butera, Bart Meyns, Joeri Van Puyvelde, lliya Yemets, Elshad Bairamov, Andrzey Kansy, Matej Nosal, Marien Lenoir, Gaetano Gargiulo, Emanuela Angeli, Thomas Martens, Thierry Bove, Carlo Pace Napoleone, Mauro Lo Rito, Alessandro Giamberti, Konstantinos Dimopoulos, Claudia Montanaro, Stefano Marianeschi, Alvaro Gonzalez Rocafort, Biagio Castaldi, Dario Gregori, Giovanni Di Salvo, Giovanni Meliota, Gabriele Scalzo, Giuseppe Scrascia, Guido Michielon, Vladimiro Vida, George Sarris, Andrew Constantine, Massimo A. Padalino
Institutions: University of Padua, Ospedale Monaldi, Leiden University Medical Center, Deutsches Herzzentrum München, Ludwig-Maximilians-Universität München, Mitera Hospital, Kepler Universitätsklinikum, Bambino Gesù Children's Hospital, Universitair Ziekenhuis Leuven, Children's Memorial Health Institute, National Institute of Cardiovascular Diseases, Hôpital de la Timone, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, Ghent University Hospital, Ospedale Regina Margherita, IRCCS Policlinico San Donato, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Royal Brompton Hospital, Fondazione Bambino Gesù, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Hospital Universitario La Paz, Hospital Universitario Ramón y Cajal, Ospedale Pediatrico Giovanni XXIII, University of Bari Aldo Moro, Istituto Giannina Gaslini, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,431
OpenAlex ID: W7170786389