An Easy Modification of Tube Graft Interposition During Fenestration in Borderline Fontan Circulation

Abstract

One of the options for the management of borderline/failing extracardiac Fontan circulation is surgical creation of an atrial fenestration to decompress the systemic venous compartment and improve cardiac output. Depending on the body surface area of the patient, a 5- to 10-mm polytetrafluoroethylene (PTFE) tube graft can be used. When fenestration is required in a patient with failing Fontan circulation, particularly in redo cases, application of a side-biting clamp may be challenging because of adhesions and a thickened atrial wall. In this article, we present our off-pump technique of atrial-side anastomosis of PTFE graft interposition between an extracardiac Fontan conduit and the atrium without using a side-biting clamp.

Modified extracardiac Fontan with a fenestrated pericardial patch

“…Short‐term patency of the fenestration is a technical challenge in itself and there is still no consensus on a practical and effective technique to ensure long term patency of the fenestration for as long as it is physiologically required 2 . Several techniques have been proposed, but none of these have proven to be definitively effective 3,4 . Below, we describe a case series of patients undergoing extracardiac Fontan with a modification that includes the interposition of a fenestrated biological patch between the conduit and the common atrium as a strategy for improved long term patency of the fenestration.…”

“…2 Several techniques have been proposed, but none of these have proven to be definitively effective. 3,4 Below, we describe a case series of patients undergoing extracardiac Fontan with a modification that includes the interposition of a fenestrated biological patch between the conduit and the common atrium as a strategy for improved long term patency of the fenestration.…”