• Supreet P Marathe, Ajay J Iyengar, Kim S Betts, Karin du Plessis, Gananjay G Salve, Robert N Justo, Prem Venugopal, David S Winlaw, Yves d'Udekem, and Nelson Alphonso.
• Queensland Paediatric Cardiac Services, Queensland Children's Hospital, Brisbane, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Australia.
• J. Thorac. Cardiovasc. Surg. 2021 Mar 1; 161 (3): 1126-1135.

ObjectiveFontan takedown remains an option for the management of Fontan failure. We sought to evaluate early and late outcomes after Fontan takedown.MethodsThe Australia and New Zealand Fontan Registry was interrogated to identify all patients who had a Fontan takedown.ResultsOver a 43-year study period (1975-2018), 36 of 1540 (2.3%) had a Fontan takedown. The median age at takedown was 5.1 years (interquartile range [IQR], 3.7, 7.0). Nine (25%) patients had a takedown within 48 hours, 6 (16%) between 2 days and 3 weeks, 14 (39%) between 3 weeks and 6 months, whereas 7 (19%) had a late takedown (>6 months). Median interval to takedown was 26 days (IQR, 1.5, 127.5). Sixteen (44%) patients died at a median of 57.5 days (IQR, 21.8, 76.8). The greatest mortality occurred between 3 weeks and 6 months (<2 days: 1/9, 11%; 2 days to 3 weeks: 2/6, 33%; 3 weeks to 6 months: 11/14, 79%; >6 months: 2/7, 28%; P = .007). At median follow-up of 9.4 years (IQR, 4.5, 15.3), 11 (31%) patients were alive with an intermediate circulation (10 in New York Heart Association class I/II). Five (14%) patients underwent a successful second Fontan. Freedom from death/transplant after Fontan takedown was 59%, 56%, and 52% at 1, 5, and 10 years, respectively.ConclusionsThe incidence of Fontan takedown is low, but mortality is high. The majority of takedowns occurred within 6 months. Mortality was lowest when takedown occurred <2 days and highest between 3 weeks and 6 months. A second Fontan is possible in a small proportion of survivors.Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.

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