title: The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, The University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock 72202-3591, USA.
authors.forename: Anji T
authors.initials: AT
authors.lastname: Yetman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Drummond-Webb
authors.forename: William P
authors.initials: WP
authors.lastname: Fiser
authors.forename: Michael L
authors.initials: ML
authors.lastname: Schmitz
authors.forename: Michiaki
authors.initials: M
authors.lastname: Imamura
authors.forename: Sana
authors.initials: S
authors.lastname: Ullah
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Gunselman
authors.forename: Carl W
authors.initials: CW
authors.lastname: Chipman
authors.forename: Charles E
authors.initials: CE
authors.lastname: Johnson
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Van Devanter
mesh_terms: 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