Fenestration improves clinical outcome of the fontan procedure: a prospective randomized study

Lemler, Matthew S.; Scott, William; Leonard, Steven; Stromberg, Daniel; Ramaciotti, Claudio

doi:10.1016/s1062-1458(02)00752-3

Cited by 86 publications

(127 citation statements)

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“…Confirmation of a reduction in the length of ICU stay or the thoracic drainage of these patients as has been reported in the literature [9] was not possible in our study, as has also been previously reported in other publications [10,11]. Thus, in this cohort, the mean thoracic drainage, during the first week, was 1,600 mL in the fenestrated patients and 1,890 mL in the non-fenestrated.…”

Section: Resultssupporting

confidence: 88%

“…This makes several authors [9,[10][11][12][13][14][15][16][17][18][19][20][21] recommend the use of conduits that might be compatible with the lives of adults (diameters of 20 to 22 mm) and that should be utilized in over 3-and 4-year-old patients with a weight of more than 15 kg. The utilization of oversized conduits in young patients, as an attempt of adapting the diameter to a longer evolution, does not seem to be the best choice as this might induce a greater tendency for the formation of laminar thrombosis.…”

Section: Commentsmentioning

confidence: 99%

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Extracardiac conduit in total cavopulmonary connection

Paulista

Souza

Chaccur

et al. 2003

Rev Bras Cir Cardiovasc

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Objective: This study evaluates a new technique of an extracardiac conduit in total cavopulmonary connection in complex congenital heart disease.Methods: Between May 2000 and October 2002, 18 extracardiac conduit surgeries were performed. The patients' weights ranged from 11 to 29 kilograms, the ages ranged from 1 to 12 years old and 10 patients were male. There were eight patients with tricuspid atresia, eight with univentricular heart, and two with unbalanced total atrioventricular septal defect. There were 17 patients who had been submitted to a previous palliative surgery. The surgery was performed at over 32º centigrade without aortic ischemia. Ten PTFE, 4 Hemashield and 4 bovine pericardium tubes were used with diameters ranging from 16 to 22 mm.Results: There were four cases of tube thrombosis and these patients were a reoperation was performed with one death. In one patient a takedown was performed on the 69 th postoperative day. There were three deaths, one due to tube thrombosis and two due to low cardiac output.Conclusion: Extracardiac conduit is already used for total cavopulmonary connection, but despite encouraging early results, a longer follow-up is necessary to prove its real advantages.

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Section: Resultssupporting

confidence: 88%

Section: Commentsmentioning

confidence: 99%

Extracardiac conduit in total cavopulmonary connection

Paulista

Souza

Chaccur

et al. 2003

Rev Bras Cir Cardiovasc

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“…4,5,11,12 Important procedural modifications, including the use of a fenestration and modified ultrafiltration, are also associated with declining mortality rates. 5,7,15,16 Fontan failure requiring takedown or need for mechanical support with ECMO is also rare in the current surgical era. 4,8,17 Risk factors for early failure as described by Gentles et al include preoperative mean pulmonary artery pressure, younger age, heterotaxy syndrome, right-sided tricuspid valve as the only systemic AVV, pulmonary artery distortion, nonfenestration, and longer bypass time.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Prolonged Recovery After the Fontan Operation

et al. 2008

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Background-Mortality and major morbidity after the Fontan operation is low in the current era. However, factors contributing to prolonged postoperative recovery are not clearly understood. Methods and Results-Data on all patients admitted to the cardiac intensive care unit (CICU) after a Fontan operation between June 2001 and December 2005 were retrospectively analyzed. We excluded all patients who died, required Fontan takedown, or required ECMO. The study cohort was further divided into a prolonged recovery group that included patients with Ͼ75%ile for duration of mechanical ventilation or pleural drainage, and a standard recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables between the prolonged and standard recovery groups. There were 226 Fontan operations performed. Of the study population (nϭ218), the median age was 2.61 years (1.0 to 31.9 years) and weight was 12.45 kg (8.4 to 77.5 kg). The most common diagnosis was hypoplastic left heart syndrome (nϭ80, 36.7%). A systemic right atrioventricular valve was present in 139 (63.7%). The lateral tunnel fenestrated Fontan was the most common surgery (nϭ195, 89.4%). Within the study population, 81 (38%) patients meet criteria for prolonged recovery. Univariate risk factors for prolonged recovery included higher preoperative PVR (Pϭ0.033), longer bypass times (Pϭ0.009), higher postbypass lactate level (Pϭ0.017), higher postoperative central venous (PϽ0.001) common atrial pressure (Pϭ0.042), inotropic score (PϽ0.001), and need for greater volume resuscitation during the 24 postoperative hours (Ͼ75% for the entire group; PϽ0.001). In a multivariable model, need for greater volume resuscitation (OR 2.81, 95% CI 1.30, 6.05) was the only independent risk factor for prolonged outcome after the Fontan operation. Conclusions-High volume expansion in the early postoperative period is an independent risk factor for prolonged recovery. The need for high volume expansion may represent the compound effects of multiple risk factors including preoperative hemodynamics and a marked systemic inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate prolonged recovery. (Circulation. 2008;118[suppl 1]:S171-S176.)

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“…The effect size of 3.5 additional days alive and out of the hospital was chosen, given similar or greater impact of other interventions in Fontan patients and based on the effect size seen in a trial of empirical perioperative nesiritide infusions in complex adult cardiac surgery patients. 5,12,13 The primary analysis was intention to treat and included all patients who were randomly assigned. Some patients received open-label milrinone once the blinded study drug infusion had been discontinued for lack of efficacy.…”

Section: Resultsmentioning

confidence: 99%

Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

Costello

Dunbar‐Masterson

Allan

et al. 2014

Circ: Heart Failure

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Background-We sought to determine whether empirical nesiritide or milrinone would improve the early postoperative course after Fontan surgery. We hypothesized that compared with milrinone or placebo, patients assigned to receive nesiritide would have improved early postoperative outcomes. Methods and Results-In a single-center, randomized, double-blinded, placebo-controlled, multi-arm parallel-group clinical trial, patients undergoing primary Fontan surgery were assigned to receive nesiritide, milrinone, or placebo. A loading dose of study drug was administered on cardiopulmonary bypass followed by a continuous infusion for ≥12 hours and ≤5 days after cardiac intensive care unit admission.

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Fenestration improves clinical outcome of the fontan procedure: a prospective randomized study

Abstract: Background-The

Cited by 86 publications

References 1 publication

Extracardiac conduit in total cavopulmonary connection

Extracardiac conduit in total cavopulmonary connection

Factors Associated With Prolonged Recovery After the Fontan Operation

Impact of Empiric Nesiritide or Milrinone Infusion on Early Postoperative Recovery After Fontan Surgery

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