Early results of the extracardiac conduit Fontan operation

Petrossian, Ed; Reddy, V. Mohan; McElhinney, Doff B.; Akkersdijk, G.P.; Moore, Phillip; Parry, Andrew J.; Thompson, LeNardo; Hanley, Frank L.

doi:10.1016/s0022-5223(99)70288-6

Cited by 144 publications

(91 citation statements)

References 28 publications

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“…Early implementation of Fontan physiology is of crucial importance for the future of a patient with a single ventricle. It should be done before the development of collateral circulation (associated with severe cyanosis) and before the development of regurgitation of atrioventricular valves, caused on the one hand by volume overload of the ventricle and on the other by its dysfunction (consequence of the myocardial fibrosis caused by chronic hypoxia) [9][10][11][12][13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Results of the Fontan operation with no early mortality in 248 consecutive patients

2017

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A b s t r a c t Background:The Fontan operation has undergone several modifications and today is the primary way to treat a broad spectrum of congenital heart defects. Aim:The purpose of this study is to present the results of treatment of children with a single ventricle operated by the same surgical team and managed according to a uniform strategy. Methods:In the years 2007-2015, in 248 children aged 3.7 ± 2.6 years and weighing 14.6 ± 6.1 kg with a single ventricle, Fontan surgery was performed. In 56 (22.6%) children surgery was based on the creation of an intra-atrial lateral tunnel, and in 192 (77.4%) patients extracardiac modification was performed. In most patients, the operation was carried out with the normothermic cardiopulmonary bypass, on a "beating heart" without aortic cross-clamp. The average cardiopulmonary bypass time was 53.9 ± 23.9 min. The most common indication for surgery was hypoplastic left heart syndrome (53.6%). All patients with a single ventricle referred to our hospital for the Fontan procedure were enrolled into the surgery programme.Results: All patients survived the operation and were discharged home. Thirty-six (14.5%) patients were extubated in the operating room, in other patients the mean duration of the mechanical ventilation was 9.7 ± 16.1 h (median 7 h). The average time of hospitalisation in the whole study group was 17.5 ± 18.5 days (median 15 days). After surgery, in four children transient seizures occurred, and three patients had an ischaemic stroke. Conclusions:Developing and obeying a fixed perioperative protocol is crucial for low mortality and small number of complications after Fontan operation.

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Section: Discussionmentioning

confidence: 99%

Results of the Fontan operation with no early mortality in 248 consecutive patients

2017

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“…This extracardiac technique may also help in immediate evolvement, decreasing mean time of thoracic drainage, even in the absence of fenestration, which was performed in 24 (47%) of the 51 patients evaluated by Petrossian et al 11 . This benefit was also shown by Lardo et al 12 .…”

Section: Discussionmentioning

confidence: 99%

Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

Atik¹,

Ikari

Martins

et al. 2002

Arq. Bras. Cardiol.

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Objective -To compare immediate and late results in patients with or without fenestration who underwent cavopulmonary anastomosis so that we could assess the efficiency of the technique. Methods -Sixty-two patients underwent surgery between 1988 and 1999, 41 with fenestration (group I -G I) and 21 without fenestration (group II -G II). Tricuspid atresia was prevalent in group I (23-56%) and single ventricle was prevalent in group II (14-66%).

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“…Most of these resolved within 48 hours of surgery, and no patients required a permanent pacemaker at the time of discharge. 19 Despite these data, there is considerable variability in definition and criteria for arrhythmia reporting, making direct comparison between techniques and studies challenging. As such, not all studies show an improved arrhythmia profile with the extracardiac Fontan.…”

Section: Advantage 3: Reduced Arrhythmiasmentioning

confidence: 99%

Is the Extracardiac Conduit the Preferred Fontan Approach for Patients With Univentricular Hearts?

Kogon

2012

Circulation

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W ith improvements in technology, operative technique, and critical care medicine, more and more children with congenital heart disease are surviving into adulthood. As they age, these patients are providing physicians with new challenges, and we are realizing the long-term consequences of our previous interventions. This oftentimes has changed the mode of treatment for subsequent children. Response by Khairy and Poirier on p 2515Fontan palliation for single-ventricle patients was first described in 1971. 1 The original approach was in the form of a classic atriopulmonary Fontan connection, bypassing the nonfunctional right ventricle. After recognizing the long-term complication of an atriopulmonary connection (right atrial dilation, arrhythmias, and thrombus formation), modifications have been made. The atriopulmonary connection has been abandoned in favor of modified Fontan anatomy and physiology.The modified Fontan can be performed by the use of an extracardiac conduit approach or a lateral tunnel approach. The extracardiac Fontan uses an external conduit to anastomose the inferior vena cava into the pulmonary arteries, whereas a lateral tunnel Fontan uses a baffle within the right atrium (Figure 1). Because the systemic venous pathway is completely separated from the right atrium with the extracardiac Fontan, it is more challenging for the electrophysiologist to access the heart for ablation. My aim is to demonstrate why "the extracardiac conduit is the preferred Fontan approach for patients with univentricular hearts."The extracardiac Fontan has several advantages over the lateral tunnel Fontan. Advantage 1: Reduced Cardiopulmonary Bypass and Ischemic TimesMinimizing cardiopulmonary bypass and ischemia may optimize early postoperative outcomes. In multiple studies, both prolonged cardioplegic arrest and extended cardiopulmonary bypass times have been associated with an increased risk of early postoperative death or Fontan failure. [2][3][4] The technique of Fontan construction often dictates whether cardiopulmonary bypass or a period of ischemic arrest are required. With the lateral tunnel Fontan, the right atrium is opened for creation of the inferior vena cava baffle, necessitating the use of cardiopulmonary bypass. In addition, a period of cardioplegic arrest is required to stop the heart to prevent air embolic events until the atrium is closed. With the extracardiac Fontan, the right atrium is not opened. Vascular control is achieved at the right atrial-inferior vena cava junction. The inferior vena cava is transected and sewn to the extracardiac conduit, and the cardiac opening is oversewn. Vascular control of the pulmonary arteries is then achieved, and the conduit is sewn to the right pulmonary artery. Last, side-biting clamps are placed on the right atrium and conduit to create a fenestration if desired. With the use of this

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Early results of the extracardiac conduit Fontan operation

Abstract: The extracardiac conduit Fontan procedure can be performed with minimal mortality and morbidity. Improved results may be related to advantages of the extracardiac approach and improved preservation of ventricular and pulmonary vascular function.

Cited by 144 publications

References 28 publications

Results of the Fontan operation with no early mortality in 248 consecutive patients

Results of the Fontan operation with no early mortality in 248 consecutive patients

Fontan Operation and the Cavopulmonary Technique: Immediate and Late Results According to the Presence of Atrial Fenestration

Is the Extracardiac Conduit the Preferred Fontan Approach for Patients With Univentricular Hearts?

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