Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms

Ikai, Akio; Fujimoto, Yoshifumi; Hirose, Katsumi; Ota, Nakao; Tosaka, Yuko; Nakata, Tomohiro; Ide, Yuya; Sakamoto, Kisaburo

doi:10.1016/j.jtcvs.2007.12.013

Cited by 31 publications

(16 citation statements)

References 18 publications

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“…Age and weight-for-age z-scores were categorized for descriptive purposes based on the distribution of the data: age 0–2 years, 2–4 years, and >4 years; and weight-for-age z-score <−2, −2 to 0, and >0. Weight was categorized as <10 kg vs. ≥10 kg based on previous studies suggesting weight <10 kg was a significant risk factor for poor outcome (6). …”

Section: Methodsmentioning

confidence: 99%

“…There was substantial variation from center-to-center in patient weight at Fontan operation, but similar to age, we did not find weight to be significantly associated with post-operative outcomes. Ikai et al evaluated 72 patients from a single institution and found that weight <10kg was a significant risk factor for prolonged length of stay (6). In contrast, our findings are consistent with several more recent studies suggesting lower weight at Fontan operation is not a risk factor for poor outcome (8,11,24–26).…”

Section: Commentmentioning

confidence: 99%

“…Others have reported that younger age at Fontan is associated with increased morbidity and mortality (3–5). There are also conflicting reports regarding weight with some studies suggesting that lower weight at Fontan operation (in particular weight <10 kg) is a risk factor for post-operative morbidity, while others have not shown this to be the case (6–8). …”

Section: Introductionmentioning

confidence: 99%

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Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

Wallace

Jaggers

et al. 2011

The Annals of Thoracic Surgery

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Background The impact of age and weight on outcomes following the Fontan operation is unclear. Previous analyses have suggested that lower weight-for-age z-score is an important predictor of poor outcome in patients undergoing bidirectional Glenn. We evaluated variation in age, weight, and weight-for-age z-score at Fontan across institutions, and the impact of these variables on post-operative morbidity and mortality. Methods Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Fontan operation (2000–2009) were included. Center variation in age, weight, and weight-for-age z-score were described. Multivariable analysis was performed to evaluate the impact of age, weight, and weight-for-age z-score on in-hospital mortality, Fontan failure (combined in-hospital mortality and Fontan takedown/revision), post-operative length of stay, and complications, adjusting for other patient and center factors. Results A total of 2747 patients (68 centers) were included: 61% male; 45% right dominant lesions (38% left dominant, 17% undifferentiated). An extracardiac conduit Fontan (vs. lateral tunnel) was performed in 63%; 65% were fenestrated. Median age and weight at Fontan operation and proportion with weight-for-age z-score <−2 varied across centers ranging from 1.7–4.8 yrs, 10.5–16.1 kg, and 0%–30%, respectively. In multivariable analysis, age and weight were not significantly associated with outcome. Weight-for-age z-score <−2 was associated with increased in-hospital mortality (OR 2.73, 95%CI 1.09–6.86), Fontan failure (OR 2.59, 95%CI 1.24–5.40), and longer length of stay (+1.2 days, 95%CI 0.1–2.4). Conclusions Weight-for-age z-score <−2 is associated with significant morbidity and mortality following the Fontan operation independent of other patient and center characteristics.

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Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

Wallace

Jaggers

et al. 2011

The Annals of Thoracic Surgery

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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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“…Ikai et al (11) report on extracardiac conduit Fontan operation in 36 patients Ͻ10 kg and compared them with patients weighing more than 10 kg with similar hemodynamic status and operative procedures. Post-operative courses were identical in both groups except that smaller patients received slightly longer ventilator support, longer pleural drainage, and 8 days versus 7 days in intensive care.…”

Section: Fontan Surgerymentioning

confidence: 99%

The Year in Congenital Heart Disease

Graham

2008

Journal of the American College of Cardiology

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Long-Term Management of Tetralogy of Fallot (TF)Articles related to long-term management of the status of older children and young adults after repair of TF include issues related to assessment of pulmonary regurgitation and timing pulmonary valve replacement as well as indications for and results of implantation of defibrillators.Gengsakul et al.(1) report a matched cohort study of 82 patients with pulmonary valve replacement (PVR) after TF repair without a history of ventricular arrhythmia who were compared with non-PVR control subjects. Oxygen consumption at peak exercise did not change in either group. For PVR subjects, there was a significant reduction in pulmonary valve regurgitation (PR), tricuspid valve regurgitation (TR), and right ventricular (RV) size and dysfunction on echocardiography. Symptoms and functional class improved after PVR, but a change in arrhythmia was not detected. There were no sudden deaths in the PVR subjects, whereas 4 patients died suddenly in the non-PVR group.Meijboom et al.(2) report on 67 patients who were followed from 15 Ϯ 3 years until 27 Ϯ 3 years after TF surgery. Twenty-two patients had mild-to-moderate PR, and no significant changes occurred during follow-up. Of 45 patients with severe PR and severe RV dilation, 28 (62%) remained free of symptoms and did not undergo PVR. No additional changes in RV size or exercise capacity were found. Seventeen patients had symptoms and underwent PVR; 9 of 17 improved clinically and echocardiographically, and QRS duration shortened. Refraining from PVR in asymptomatic patients led to no measurable deterioration in 25 of 28 patients. Referring symptomatic patients for PVR led to improvement in 9 of 17 patients. This article highlights the dilemma in following asymptomatic patients with significant PR. Although most showed no measurable deterioration, in 24% there were questionable or unsatisfactory results for this type of management.Henkens et al.(3) analyzed the influence of pre-operative PR severity and RV size and function on outcome in 27 adults who had cardiac magnetic resonance imaging (MRI) before and after PVR. PR was not related to RV dimensions or function before PVR, and severity of PR did not influence changes in RV dimensions after PVR. These data suggest that the timing of PVR should be based on indexed RV end-systolic volume and corrected RV ejection fraction (EF) rather than severity of PR. It is unclear how PR cannot be related to RV dimensions in this article. Nevertheless, the preceding 3 reports emphasize that diligence is needed in follow-up of these patients and MRI, plus exercise studies can help in providing optimal timing for PVR before deterioration of RV function occurs. This can be a difficult enterprise despite all of our efforts. If we had a perfect valve it would be much easier, but such is not the case.Khairy et al. (4) report on implantable cardioverterdefibrillators (ICDs) in TF patients. A total of 121 patients were enrolled and followed for a median of 3.7 years. The ICDs were implanted for primary pr...

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Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms

Abstract: The early outcome of the extracardiac conduit Fontan procedure was satisfactory in patients weighing less than 10 kg. However, the required size of the conduit remains debatable.

Cited by 31 publications

References 18 publications

Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

Center Variation in Patient Age and Weight at Fontan Operation and Impact on Postoperative Outcomes

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

The Year in Congenital Heart Disease

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