Early outcomes of fenestrated intra‐extracardiac Fontan procedure: Insights, experiences, and expectations

Abstract

Background: Intraextracardiac Fontan procedure (FP) aimed to combine the advantages of lateral tunnel and extracardiac conduit modifications of the original technique. Herein, we present our early outcomes in patients with intraextracardiac fenestrated FP.Methods: A retrospective analysis was performed to evaluate intraextracardiac fenestrated Fontan patients between 2014 and 2021. Seventeen patients were operated on with a mean age and body weight of 9.1 ± 5.5 years and 28.6 ± 14.6 kg.Results: Sixteen patients (94%) were palliated as univentricular physiology with hypoplasia of one of the ventricles. One patient (6%) with well-developed two ventricles with double outlet right ventricle and complete atrioventricular septal defect had straddling of the chordae prohibiting a biventricular repair. All of the patients had cavopulmonary anastomosis before Fontan completion, except one case. Fenestration was performed in all cases. Postoperative mean pulmonary artery pressures and arterial oxygen saturation levels at follow-up were 10 ± 2.4 mmHg and 91.3 ± 2.7%, respectively. Mean duration of pleural drainage was 5.4 ± 2.3 days. All of the fenestrations are patent at a mean follow-up period of 4.8 ± 7.7 years, except one case. Any morbidity and mortality were not encountered.Conclusions: Early outcomes of intraextracardiac fenestrated FP are encouraging. This procedure may improve the results in a patient population who should be palliated as univentricular physiology, especially in cases with complex cardiac anatomy.cavopulmonary anastomosis, congenital heart disease, Fontan procedure, single ventricle 1 | INTRODUCTION Fontan procedure (FP) has been performed as the common destination treatment for patients with single ventricle physiology, since it was defined in the early 1970s. At first, Dr. Francis Fontan defined this surgical procedure by performing an atriopulmonary connection in three patients with tricuspid atresia, which was the prototype of true single ventricle morphology. 1 Following the first years of FP, many modifications were defined as well as the indications of this palliative procedure were extended. Apart from single ventricle morphology, cases in which satisfactory septation could not be achieved such as double outlet right ventricle (DORV) with a remote ventricular septal defect (VSD), FP was the procedure of choice. 2Probably, there has been no other palliative surgical procedure other than the Fontan circulation in the historical development of congenital heart diseases that had significant modifications with