Modified extracardiac Fontan with a fenestrated pericardial patch

Abstract

Extracardiac Fontan is a preferred treatment strategy in many centers treating patients with single ventricle physiology, and many of these centers regularly include a fenestration between the extracardiac conduit and the common atrium. Spontaneous closure of the fenestration is a common complication of this technique and is independently associated with increased morbidity and mortality. Recently, we introduced a novel technique for fenestration of the extracardiac conduit wherein a pericardial patch is utilized at the fenestration point with excellent outcomes in the midterm fenestration patency rates, thus reducing the risk of acute post‐Fontan complications.

The evolution of surgical technique of the fenestrated Fontan procedure

“…Guariento et al 1 introduce a novel modification for fenestration of the extracardiac conduit in patients undergoing the Fontan procedure for the treatment of single ventricle physiology. They report their midterm fenestration patency results in 48 patients from June 2008 to December 2018.…”

Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis

“…The Fontan operation, which may be performed with various surgical techniques, is the final stage of surgical palliation for functionally univentricular hearts (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A surgically created fenestration (or connection) between the Fontan circuit and the atrial cavity to reduce excessively elevated systemic venous pressures and to improve cardiac output by increasing the filling of the single ventricle may be beneficial in the immediate postoperative period (21)(22)(23)(24). To date, the only available prospective randomized study examining the impact of Fontan fenestration demonstrated a reduction in hospital and intensive care unit length of stays with a fenestration (25), even if other studies reported data on this issue (26)(27)(28).…”