Fontan Operation: A Comparison of Lateral Tunnel with Extracardiac Conduit

• Published in: The Annals of thoracic surgery Vol. 83; no. 2; pp. 622 - 630
• Main Authors: Fiore, Andrew C., MD, Turrentine, Mark, MD, Rodefeld, Mark, MD, Vijay, Palaniswamy, PhD, Schwartz, Theresa L., MD, Virgo, Katherine S., PhD, Fischer, Laurice K., MD, Brown, John W., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.02.2007
• Subjects: Arrhythmias, Cardiac - etiology; Blood Pressure; Cardiothoracic Surgery; Child; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Fontan Procedure - adverse effects; Fontan Procedure - methods; Fontan Procedure - mortality; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Heart Rate; Humans; Incidence; Infant; Male; Mitral Valve Insufficiency - etiology; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; Patient Readmission - statistics & numerical data; Pericardial Effusion - etiology; Postoperative Period; Stroke Volume; Surgery; Survival Analysis; Treatment Outcome; 21
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.09.070

Background The purpose of this report is to compare the outcome of the extracardiac (EC) with the lateral tunnel (LT) Fontan. Methods From January 1990 to October 2004, the Fontan operation was performed in 162 patients, of which 49 were EC and 113 were LT. Cardiac morphology and ventricular dominance were similar, except EC patients were older and had a greater frequency of heterotaxy syndrome, and LT patients had a higher incidence of hypoplastic left heart syndrome. Preoperative transpulmonary gradient, ventricular end-diastolic pressure, McGoon index, room air saturation, and cardiac rhythm were similar. EC patients underwent superior caval pulmonary connection, and LT patients underwent hemi-Fontan. Cardiopulmonary bypass time was similar, but fewer EC patients needed aortic cross-clamping. Fenestration was more frequent in LT patients (EC, 16% versus LT, 73%; p < 0.01). Results Overall operative mortality was 1.8% (EC, 1 versus LT, 2; p = NS). Postoperative transpulmonary gradient, readmission for chylous effusion, and change in ejection fraction relative to preoperative level did not differ between cohorts. Resource utilization was higher in the EC group. The loss of sinus rhythm and the frequency of all neurologic events did not differ. There were seven late deaths (EC 4 versus LT 3; p = NS ). Actuarial survival at 5 years was not significantly different (EC, 90% versus LT, 95%; p = 0.08). Conclusions The EC and LT operation had comparable early and late mortality, readmission for chylous effusion, preservation of sinus rhythm, and frequency of all neurologic events. The more frequently fenestrated LT cohort used fewer resources.