title: Synthetic antifibrinolytics are not associated with an increased incidence of baffle fenestration closure after the modified Fontan procedure.
abstract: OBJECTIVE
  To determine if the lysine analog antifibrinolytic agents, epsilon-aminocaproic acid and tranexamic acid, are associated with early closure of the baffle fenestration after the modified Fontan procedure.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Seventy-four successive patients underwent the modified Fontan procedure. Three patients received aprotinin and were excluded. A total of 71 patients were analyzed.
  
  
  METHODS
  Charts were examined for variables known to be associated with baffle fenestration closure in the modified Fontan procedure.
  
  
  RESULTS
  Occurrence of baffle fenestration closure, oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, intensive care unit (ICU) duration, and total inpatient duration were compared between the 33 patients who received antifibrinolytics and the 38 patients who did not. One patient of 71 had baffle fenestration closure in the first 48 hours after surgery. Oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, chest tube drainage duration, days in ICU, and total inpatient duration were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Use of epsilon-aminocaproic acid and tranexamic acid is not associated with early baffle fenestration closure after the modified Fontan procedure. It is concluded that these agents can be used without increasing the risk of spontaneous baffle fenestration closure.
authors.affiliation: Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Gruber
authors.forename: A C
authors.initials: AC
authors.lastname: Shukla
authors.forename: R W
authors.initials: RW
authors.lastname: Reid
authors.forename: P R
authors.initials: PR
authors.lastname: Hickey
authors.forename: D D
authors.initials: DD
authors.lastname: Hansen
mesh_terms: D015119:Aminocaproic Acid / Q000009:adverse effects*; D000933:Antifibrinolytic Agents / Q000009:adverse effects*; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D018729:Fontan Procedure / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology*; D014148:Tranexamic Acid / Q000009:adverse effects*; D018785:Tricuspid Atresia / Q000601:surgery*
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid; D015119:Aminocaproic Acid