An assessment of Fontan procedure outcomes and how we can reduce post-Fontan complications.
Padalino, Massimo A Imperatore, Giuseppe Crea, Domenico Castaldi, Biagio Hörer, Jürgen Meyns, Bart Montanaro, Claudia Sames Dolzer, Eva Sarris, George Bottio, Tomaso
Padalino, Massimo A
Imperatore, Giuseppe
Crea, Domenico
Castaldi, Biagio
Hörer, Jürgen
Meyns, Bart
Montanaro, Claudia
Sames Dolzer, Eva
Sarris, George
Bottio, Tomaso
Abstract
Introduction
The Fontan procedure and its modifications have dramatically transformed prognosis in individuals with single ventricle physiology, yet long-term outcomes remain challenging due to the high incidence of short and long-term complications. Common issues include arrhythmias, heart failure, Fontan-associated liver disease and an increasing need for reintervention or transplantation, all of which substantially impact on patients' quality of life and longevity. As this population ages, late cardiac and extracardiac complications are common, which underscores the need for ongoing monitoring and comprehensive multidisciplinary care aimed at early and effective management.
Areas covered
This review summarizes current evidence on the long-term outcomes after Fontan-type surgery. It describes the unique pathophysiology of the Fontan circuit, and critically evaluates incidence, severity, and management strategies for common cardiac and extracardiac complications, focusing on established clinical practice and recent advances. The review also highlights the value of continued specialist multidisciplinary care.
Expert opinion
Emerging research supports the potential of novel medical therapies and devices to further improve outcomes, yet optimal care remains grounded in multidisciplinary management rather than experimental approaches. Continued research is vital to support clinical guidelines and improve the quality of life and outcomes of individuals living with a Fontan-type circulation.
MIDER Authors
Affiliations
Date
2025-11-21
Type
Article
Collections
Citation
Padalino MA, Imperatore G, Crea D, Castaldi B, Hörer J, Meyns B, Montanaro C, Sames Dolzer E, Sarris G, Bottio T, Constantine A, Dimopoulos K. An assessment of Fontan procedure outcomes and how we can reduce post-Fontan complications. Expert Rev Cardiovasc Ther. 2025 Dec;23(12):883-902. doi: 10.1080/14779072.2025.2591333. Epub 2025 Nov 21.