Frontiers in Fontan failure: Innovation and improving outcomes: A conference summary
Georges Ephrem1, Camden Hebson2, Anitha John3, Estella Moore4, Maan Jokhadar4, Ryan Ford5, Gruschen Veldtman6, Yoav Dori7, Michelle Gurvitz8,9, Brian Kogon10, Adrienne Kovacs11, Meghan Roswick, Michael McConnell12, Wendy M. Book4, Fred Rodriguez III4,12
1 Peter Munk Cardiac Centre, University
Health Network, Toronto, Canada
2 Division of Cardiology, Department
of Pediatrics, Children’s of Alabama,
Birmingham, Alabama
3 Division of Pediatric Cardiology, Children’s
National Health System, Washington,
District of Columbia
4 Division of Cardiology, Department of
Medicine, Emory University School of
Medicine, Atlanta, Georgia
5 Division of Gastroenterology, Department
of Medicine, Emory University School of
Medicine, Atlanta, Georgia
6 Department of Cardiology, The Heart
Institute, Cincinnati Children’s Hospital
Medical Center, Cincinnati, Ohio
7 Division of Cardiology, Department of
Pediatrics, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania
8 Boston Children’s Hospital, Boston,
Massachusetts
9 Brigham and Women’s Hospital, Boston,
Massachusetts
10 Division of Pediatric Cardiothoracic
Surgery, University of Mississippi Medical
Center, Jackson, Mississippi
11 Knight Cardiovascular Institute, Oregon
Health & Science University, Portland,
Oregon
12 Sibley Heart Center Cardiology, Emory
University School of Medicine, Atlanta,
Georgia
* Corresponding Author: Georges Ephrem, MD, MSc, Division of Cardiology, Department of Medicine, University of Toronto, 519‐585 University Avenue, Toronto, ON M5G 2N2, Canada. Email:
Congenital Heart Disease 2019, 14(2), 128-137. https://doi.org/10.1111/chd.12685
Abstract
The initial “Frontiers in Fontan Failure” conference in 2015 in Atlanta, Georgia, provided an
opportunity for experts in the field of pediatric cardiology and adult congenital heart disease
to focus on the etiology, physiology, and potential interventions for patients with “Failing
Fontan” physiology. Four types of “Fontan Failure” were described and then published by Dr
Book et al. The acknowledgment that even Dr Fontan himself realized that the Fontan proce‐
dure “imposed a gradually declining functional capacity and premature late death after an initial
period of often excellent palliation.” The purpose of the second “Frontiers in Fontan Failure”
was to further the discussion regarding new data and technologies as well as novel interven‐
tions. The 2017 “Frontiers in Fontan Failure: Innovation and Improving Outcomes” was spon‐
sored by Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, and Emory
University School of Medicine. Future directions in the management of Fontan failure include
further investigations into the risk of sudden cardiac death and how to properly prevent it,
achievable interventions in modifying the Fontan physiology to treat or prevent late complica‐
tions, and improved and refined algorithms in Fontan surveillance. Finally, further research into
the interventional treatment of lymphatic‐related complications hold the promise of marked
improvement in the quality of life of advanced Fontan failure patients and as such should be
encouraged and contributed to.
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Cite This Article
Ephrem, G., Hebson, C., John, A., Moore, E., Jokhadar, M. et al. (2019). Frontiers in Fontan failure: Innovation and improving outcomes: A conference summary.
Congenital Heart Disease, 14(2), 128–137. https://doi.org/10.1111/chd.12685