The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results.
BACKGROUND
The extracardiac Fontan procedure (ECF) usually requires cardiopulmonary bypass (CPB). In this report, the results and techniques of this procedure without CPB at a single institution are presented.


METHODS
Between August 1992 and December 2001, ECF without CPB was achieved in 24 of 44 patients undergoing an ECF. Mean age at surgery was 5.9 +/- 2.9 years, and mean weight was 20.7 +/- 12.6 kg. Diagnoses were tricuspid atresia in 9 patients, single-ventricle with pulmonary outflow tract obstruction in 7, pulmonary atresia/intact septum in 5, and other complex single-ventricle physiology in 3. Initial palliation was by arterial to pulmonary artery shunt in 21 and pulmonary artery banding in 1. A bidirectional cavopulmonary connection was created in 23 patients. A temporary inferior vena caval-to-atrial shunt was used to complete the procedure without CPB. Median graft size was 16 mm (range 14 to 20 mm).


RESULTS
There was no early mortality, and 68% of patients were discharged without complications. Complications included persistent cyanosis in 4 patients, persistent pleural effusions in 2 (one chylous), and phrenic nerve injury in 1. Median postoperative hospital stay was 16 days (range 10 to 50) days. At a mean follow-up of 44 +/- 28 months, there was no conduit obstruction. One patient died 11 months postoperatively, and 1 patient received a heart transplant 26 months post-ECF.


CONCLUSIONS
At intermediate term follow-up, the ECF without CPB appears to be safe and technically reproducible in selected cases. Ongoing follow-up of these patients is necessary to document the theoretical advantages of avoiding CPB.
Yetman
Anji T
AT
Department of Cardiovascular Surgery, The University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72202-3591, USA.
Drummond-Webb
Jonathan
J
Fiser
William P
WP
Schmitz
Michael L
ML
Imamura
Michiaki
M
Ullah
Sana
S
Gunselman
Ryan J
RJ
Chipman
Carl W
CW
Johnson
Charles E
CE
Van Devanter
Stephen H
SH
D002675:Child, Preschool; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006352:Heart Ventricles / Q000002:abnormalities; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications; D018633:Pulmonary Atresia / Q000601:surgery; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000601:surgery