Comparison of extracardiac Fontan techniques: pedicled pericardial tunnel versus conduit reconstruction.
OBJECTIVE
This study was designed to determine whether either of 2 alternative methods of extracardiac Fontan reconstruction provides superior results.


METHODS
We reviewed 58 consecutive Fontan procedures performed between 1995 and 2001 with a pedicled pericardial tunnel (group P, n = 21) or an extracardiac conduit of polytetrafluoroethylene or allograft aorta (group C, n = 37). Operations were performed with cardiopulmonary bypass at 32 degrees C; an aortic crossclamp was applied in only 6 patients. All group P patients and 33 (89%) group C patients received fenestrations.


RESULTS
The groups were similar in terms of age, weight, anatomy, and preoperative hemodynamics. There were 3 hospital deaths (5%; 70% confidence limit, 2%-30%), all in group C. Median durations of mechanical ventilation (group P, 1 day; group C, 1 day), intensive care unit stay (group P, 3 days; group C, 3 days), chest tube drainage (group P, 8 days; group C, 7 days), and hospitalization (group P, 10 days; group C, 9 days) were not significantly different. There were no late deaths. All patients received warfarin sodium, and there were no late strokes. Before the Fontan procedure, 1 patient in group P and 3 patients in group C required pacemaker implants. Of the 51 surviving patients in sinus rhythm before the Fontan procedure, only 1 patient in group C subsequently required a pacemaker.


CONCLUSIONS
Extracardiac Fontan procedures with either a pericardial baffle or conduit are associated with low operative mortality and low risks of arrhythmia and late thromboembolic complication.
Woods
Ronald K
RK
Division of Pediatric Cardiothoracic Surgery, the University of Washington School of Medicine, Seattle, USA.
Dyamenahalli
Umesh
U
Duncan
Brian W
BW
Rosenthal
Geoffrey L
GL
Lupinetti
Flavian M
FM
D001011:Aorta / Q000637:transplantation*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002675:Child, Preschool; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006343:Heart Septal Defects / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D009017:Morbidity; D010496:Pericardium / Q000637:transplantation*; D011138:Polytetrafluoroethylene; D018633:Pulmonary Atresia / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000401:mortality / Q000601:surgery
D011138:Polytetrafluoroethylene