Comparison of somatic development and status of conduit after extracardiac Fontan operation in young and older children

• Published in: European journal of cardio-thoracic surgery Vol. 26; no. 6; pp. 1073 - 1079
• Main Authors: Ovroutski, Stanislav, Ewert, Peter, Alexi-Meskishvili, Vladimir, Stiller, Brigitte, Nürnberg, Jan-H., Abdul-Khaliq, Hashim, Hetzer, Roland, Lange, Peter E.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.12.2004; Elsevier Science
• Subjects: Adolescent; Biological and medical sciences; Cardiac Catheterization; Child; Child, Preschool; Coronary Angiography - methods; Fontan Procedure - methods; Growth; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Hemodynamics - physiology; Humans; Medical sciences; Postoperative Complications - etiology; Pulmonary Artery - pathology; Respiration, Artificial - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Time Factors; Treatment Outcome; Tricuspid Atresia - diagnostic imaging; Tricuspid Atresia - physiopathology; Tricuspid Atresia - surgery; Weight Gain - physiology; Human; Fontan procedure; Extracardiac conduit; Cardiovascular disease; Fontan operation; Somatic development; Treatment; Surgery; Development; Congenital cardiopathy; Somatic growth; Child; Comparative study
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.07.021

Objective: We set out to examine whether the extracardiac Fontan operation (ECFO) in young children is beneficial for the early postoperative course and whether it has a negative impact on the mid-term hemodynamics and growth of the children due to absent growth potential of the prosthetic conduit. Therefore we compared our medium-term experience with ECFO in children under 4 years of age to that in older children regarding the incidence of postoperative complications, somatomotoric development and conduit status. Methods and results: Between 11/95 and 12/02 ECFO was performed in 30 children under 4 years of age and 21 older children aged 4–13 years. There were no deaths in children under 4 years of age and two older children died. No prolonged support (≫72h) of suprarenin was required in small children compared to 4 older children. In twenty-seven children, who underwent postoperative heart catheterization no pulmonary artery or systemic vein distortion occurred. One re-operation and one transcatheter intervention were performed because of the partial conduit stenosis. During the median follow-up of 4.8 years a manifestly accelerated postoperative weight gain was observed in children operated on under 4 years of age, compared to that in older children (up to the 50 vs. 10th percentile, P≪0.05). Conclusions: The ECFO could be performed in young children with low morbidity and mortality rates. In the majority of patients, implanted prosthetic grafts maintain stable form without the development of stenosis. Accelerated somatic development, especially in small children, is to be observed after completion of the Fontan circulation.