{
  "abstract": "Objective\n\nThe 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\n\nA 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\n\nPropensity-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\n\nECC 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.",
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  "affiliations": [
    "Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.",
    "Pediatric and Congenital Heart Surgery Department, Monaldi Hospital, Napoli, Italy.",
    "Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.",
    "Leiden University Medical Center (LUMC), Leiden, The Netherlands.",
    "Division of Congenital and Pediatric Heart Surgery, Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Munich, Munich, Germany.",
    "Department for Pediatric and Congenital Heart Surgery, Mitera Children's Hospital, Athens, Greece.",
    "Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.",
    "Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children's, Hospital IRCCS, Rome, Italy.",
    "Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.",
    "Ukrainian Children's Cardiac Center, Kiev, Ukraine.",
    "Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland.",
    "National Institute of Cardio-Vascular Diseases, Childrens Heart Center, Bratislava, Slovakia.",
    "Department of Congenital Heart Surgery, La Timone Children Hospital, Marseille, France.",
    "Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of CardioThoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy.",
    "Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.",
    "Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy.",
    "Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.",
    "Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust: Royal Brompton and Harefield Hospitals, London, United Kingdom.",
    "Adult Congenital Heart Disease, Bambino Gesù Hospital, Rome, Italy.",
    "Congenital Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.",
    "Pediatric Cardiac Surgery and Adult Congenital Heart Disease Service, Alianza Estratégica Hospital Universitario La Paz-Hospital Universitario Ramón y Cajal, Madrid, Spain.",
    "Pediatric Cardiology Unit, Department of Woman and Child's Health, University of Padova, Padova, Italy.",
    "Pediatric Cardiology Unit, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.",
    "Pediatric Cardiac Surgery Unit, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.",
    "Congenital Cardiac Surgery, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, Bari, Italy.",
    "Congenital Heart Surgery and Heart Centre, Gaslini Children's Hospital, Genoa, Italy.",
    "Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NSH Foundation Trust, Birmingham, United Kingdom."
  ],
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  "arxiv": null,
  "author_total": 41,
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  "bibtex": "https://research.draconitic.com/paper/dhncwh1dnnwnq.bib",
  "cited_by": 0,
  "doi": "10.1016/j.xjon.2026.101970",
  "fulltext_url": "https://europepmc.org/articles/PMC13711207",
  "id": "dhncwh1dnnwnq",
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    "2666-2736"
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  "landing_url": "https://europepmc.org/article/MED/42948481",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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  "native_subjects": [
    [
      "heading",
      "Congenital: Fontan"
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      "2713|Congenital Heart Disease Studies"
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  "openalex": "W7170786389",
  "pdf_url": "https://europepmc.org/articles/PMC13711207?pdf=render",
  "pmcid": "PMC13711207",
  "pmid": "42948481",
  "published": "2026-07-24",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/dhncwh1dnnwnq.ris",
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      "first_seen": "2026-10-31T00:20:36Z",
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      "origin": "openalex:2713|Congenital Heart Disease Studies",
      "subfield": "epidemiology-public-health"
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  "title": "Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience.",
  "title_text": "Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:01Z",
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