Intraatrial Conduit Fontan Procedure: Indications, Operative Techniques, and Clinical Outcomes

Zhu, Zhong Qun; Hong, Hai Fa; Chen, Hui-Wen; Zhang, Hai Bo; Lu, Zhao; Zheng, Jing; Shi, Guo Cheng; Liu, Jing Fen

doi:10.1016/j.athoracsur.2014.08.021

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…Our previous research found that a flared junction in the IAC Fontan's procedure reduced EL compared with the LT Fontan's procedure. 3,10 Here, we further confirmed that the enlargement of the conduit-PA anastomosis site with elliptical autologous or bovine pericardium, which provides an enlarged TCPC space, can further slow the velocity and then lessen this crash phenomenon.…”

Section: Discussionsupporting

confidence: 71%

“…1,2,9,24 According to previous studies, hemodynamic parameters including, WSS, EL, and HFD could be indicators of positive long-term results. 10,11,25,26 It is generally accepted that the local hemodynamic state affects endothelial function. Laminar blood flow is known to be crucial to maintain normal vascular functioning and disrupted or oscillatory flows shown as high WSS, especially near the arterial bifurcations or surgical anastomosis region which may trigger thrombosis or hyperplasia leading to long-term stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Offset on Hemodynamics of Intra-atrial Conduit Fontan's Procedure and Its Clinical Implications

Wang

Tong

et al. 2019

Thorac cardiovasc Surg

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Background The desirable distance, defined as offset, between the central line of the superior vena cava (SVC) and the intra-atrial conduit after an intra-atrial conduit (IAC) Fontan's procedure remained unclear. We compared the hemodynamic features using virtual surgery with different offset designs in our study. Methods Three-dimensional models of IAC Fontan's procedure were reconstructed according to the magnetic resonance imagings (MRIs) of three patients, then four models for each patient with different offsets equaling 100, 67, 33, and 0% of the diameter of the IVC were reconstructed. Computational fluid dynamics (CFD) were performed in each model to predict the best hemodynamic features, including streamlines of blood flow, wall shear stress (WSS), energy loss (EL), and the hepatic flow distribution (HFD) ratio. Results Comprehensive evaluation of WSS, EL, and HFD revealed than an offset of 33% presents the best hemodynamic performance among the three patients modeled. In patient A, an offset of 33% resulted in the best HFD (left pulmonary artery/right pulmonary artery [LPA/RPA] = 35/65%). In patient B, the best trade-off between HFD (35/65%), and WSS was achieved with an offset of 33%. In patient C, EL peaked at an offset of 0% and significantly dropped at an offset of 33% with a desirable HFD (60/40%). Conclusions We verified that the offset distance influences hemodynamic performance in IAC Fontan's procedure. Considering several hemodynamic parameters, the best trade-offs between hemorheology, pulmonary perfusion, and energy efficiency were achieved at an offset of 33%. This distance should be taken into consideration and optimized during the surgical planning for the IAC Fontan's procedure.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Influence of Offset on Hemodynamics of Intra-atrial Conduit Fontan's Procedure and Its Clinical Implications

Wang

Tong

et al. 2019

Thorac cardiovasc Surg

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“…To address these drawbacks of the techniques, intra-atrial conduit and intra-extracardiac Fontan techniques have gained renewed interest, even in more standard anatomy as they allow for anterior positioning of the conduit away from the PVs and can be reliably fenestrated [27][28][29].…”

Section: Individualized Fontan Techniquesmentioning

confidence: 99%

Impact of Cardiac Position, Morphology and Operative Technique on Long-Term Fontan Outcomes in Heterotaxy

Kadowaki,

uçar,

Fan

et al. 2024

Preprint

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ObjectivesHeterotaxy is characterized by complex venous connections and cardiac position requiring individualized strategies for Fontan. This study aimed to assess 25-year outcomes of heterotaxy patients undergone Fontan operation, with particular focus on morphological features and surgical techniques.Methods82 consecutive heterotaxy patients who underwent Fontan operation from 1985 to 2021 were compared to 150 with tricuspid atresia (TA) and 144 with hypoplastic left heart syndrome (HLHS). Kaplan-Meier method and Cox proportional hazard model were used for transplant-free survival and predictor analysis.ResultsRight Atrial Isomerism (RAI) was present in 45 cases and Left Atrial Isomerism (LAI) in 37. The 20-year transplant-free survival was comparable between the groups (RAI vs. LAI, 76% [95% confidence interval, 57-87%] vs. 68% [47-82%], p=0.22). Techniques were extracardiac in 66%, intra-atrial conduit in 9%, lateral tunnel in 18%. More intervention on pulmonary veins occurred in the RAI group. Cardiac position and apicocaval juxtaposition did not influence outcome. The IVC-contralateral PA Fontan was associated with 100% survival, while the IVC-ipsilateral PA Fontan at the side of the cardiac apex showed 67% [34-87%] survival at 20 years. Moderate or severe ventricular dysfunction at 20 years was found in 15% (6-39%) and 0% of RAI and LAI patients among hospital survivors, respectively (p=0.09). In-hospital mortality was higher in heterotaxy (9.8% [5-19%]) compared to TA (1.3% [0.3-5.3%], p<.01) and HLHS (2.8% [1.1-7.3%], p=0.02). There was no in-hospital death after 2000 in any of groups. The 20-year transplant-free survival in heterotaxy (72% [59-82%]) was worse than that in TA (95% [89-97%], p<0.001) but was not significantly different from that in HLHS (80% [69-87%], p=0.11). Reintervention rate at 20 years was significantly higher in heterotaxy (18% [11-29%]) vs. HLHS (8% [4-16%]) (p=0.01). Ventricular dysfunction was a predictor for death (univariate p<0.001).ConclusionVarious routing techniques can be successfully applied to overcome the anatomical challenges of heterotaxy. Although higher in-hospital mortality and reintervention rate were found in heterotaxy in the early era, overall survival post Fontan was similar to that in HLHS. RAI had comparable survival to LAI with greater proportion requiring pulmonary vein intervention at time of Fontan.

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Invited Commentary

Overman

2015

The Annals of Thoracic Surgery

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Intraatrial Conduit Fontan Procedure: Indications, Operative Techniques, and Clinical Outcomes

Cited by 6 publications

References 19 publications

Influence of Offset on Hemodynamics of Intra-atrial Conduit Fontan's Procedure and Its Clinical Implications

Influence of Offset on Hemodynamics of Intra-atrial Conduit Fontan's Procedure and Its Clinical Implications

Impact of Cardiac Position, Morphology and Operative Technique on Long-Term Fontan Outcomes in Heterotaxy

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