Avoiding cardiopulmonary bypass in extracardiac cavopulmonary connection: Does it really matter?

Navabi, Mohammad Ali; Rastegar, Saideh M.; Kiani, Ali Asghar; Mohammad, Mahmood Gholam Ale; Asbagh, Parvin Akbari; Mirzaaghayan, Mohammad Reza; Meysamie, Ali Pasha; Shabanian, Reza

doi:10.1016/j.jtcvs.2009.10.031

Cited by 8 publications

(12 citation statements)

References 22 publications

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“…Off-bypass Fontan completion has been demonstrated to attenuate proinflammatory markers; however, multiple studies have been unable to establish consistent clinical improvements (278, 279). The largest and most recent series to evaluate Fontan completion without cardiopulmonary bypass found no difference in immediate postoperative pressures or in early outcomes including chest tube drainage, arrhythmias, or mechanical ventilation (280). Although avoidance of cardiopulmonary bypass at completion Fontan in HLHS is safe and can be done with consistent results, it appears at this juncture to have no clinical benefit to patient care and will require more study if it is to become widely adopted.…”

Section: Stage III (Fontan Operation; Total Cavopulmonary Connection)mentioning

confidence: 99%

Hypoplastic Left Heart Syndrome

Feinstein

Benson

Dubin

et al. 2012

Journal of the American College of Cardiology

445

176

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In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

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Section: Stage III (Fontan Operation; Total Cavopulmonary Connection)mentioning

confidence: 99%

Hypoplastic Left Heart Syndrome

Feinstein

Benson

Dubin

et al. 2012

Journal of the American College of Cardiology

445

176

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“…However, this study as well as others did not establish any difference in hemodynamics or postoperative clinical improvements when performing the procedure off CPB. [ 28 29 ] While our study specifically investigated the use of CPB and its relationship to duration of chest tube drainage and length of hospital stay, Navabi et al . additionally evaluated duration of mechanical ventilation, incidence of arrhythmias, and postoperative hemodynamic instability and found no meaningful differences between those who did and did not require CPB.…”

Section: Discussionmentioning

confidence: 99%

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

et al. 2020

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Objective: To investigate patient-related factors, echocardiographic, and anatomic variables associated with immediate and long-term clinical outcomes after extracardiac Fontan procedure at our institution. Materials and Methods: Retrospective review of preoperative cardiac catheterizations and echocardiograms as well as medical records of all children with hypoplastic left heart syndrome (HLHS) who underwent Fontan between June 2002 and December 2018. Results: Seventy-seven patients with HLHS were included (age 4 years [1.5–11.7]). Seventy patients (91%) received a nonfenestrated Fontan and 57 patients (74%) underwent Fontan without cardiopulmonary bypass (CPB). Presence of a Fontan fenestration ( P = 0.69) and use of CPB ( P = 0.79) did not differ between those with <2 weeks compared to those with ≥2 weeks of chest tube drainage. There were no differences in either pre- or intra-operative hemodynamics between patients who weighed <15 kg compared to those who weighed ≥15 kg at time of surgery; incidence of death, transplant, and transplant listing were similar between weight groups. Inferior vena cava (IVC) diameter z-score did not differ among patients with and without chylous chest tube drainage ( P = 0.78), with and without development of protein losing enteropathy ( P = 0.23), or death/heart transplant/transplant listing compared to survivors without transplant ( P = 0.26). Conclusion: In HLHS patients undergoing Fontan, preoperative weight and IVC diameter appeared to have no influence on immediate postoperative outcomes. Performing the Fontan off CPB and with a fenestration also conferred no added clinical benefit. These observations should be considered when deciding optimal timing for Fontan completion.

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“…Advantages of off-pump TCPC include all the advantages of extracardiac TCPC, and the surgery is performed at normothermia on beating heart, and it excludes all deleterious effects of CPB. [5][6][7]22,24,25 It has been our current strategy to perform off-pump TCPC unless the patient requires any intracardiac procedure, including patients with heterotaxy syndromes. A prior Glenn anastomosis, a systemic to PA shunt, or the need for a PA plasty is not a contraindication for this operation.…”

Section: Discussionmentioning

confidence: 99%

A Complete Extracorporeal Circulation-Free Approach to Patients With Functionally Univentricular Hearts Provides Superior Early Outcomes

Talwar

Muthukkumaran

Choudhary

et al. 2014

World J Pediatr Congenit Heart Surg

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Avoiding cardiopulmonary bypass in extracardiac cavopulmonary connection: Does it really matter?

Abstract: Avoiding cardiopulmonary bypass in fenestrated extracardiac total cavopulmonary connection had no direct effect on the early outcome variables.

Cited by 8 publications

References 22 publications

Hypoplastic Left Heart Syndrome

Hypoplastic Left Heart Syndrome

Recent outcomes of the extracardiac Fontan procedure in patients with hypoplastic left heart syndrome

A Complete Extracorporeal Circulation-Free Approach to Patients With Functionally Univentricular Hearts Provides Superior Early Outcomes

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