The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes.
OBJECTIVE
Our approach to the extracardiac conduit Fontan operation has evolved over time from full-pump, to partial-pump, to completely off-pump. This study is designed to report our overall experience with the extracardiac conduit Fontan operation and to evaluate the evolution in bypass technique on postoperative outcomes.


METHODS
From September 1992 to April 2005, 285 patients, median age 4.5 years (1.4-44 years), median weight 16 kg (9.4-94 kg), underwent a primary extracardiac conduit Fontan procedure. Early and late outcomes were analyzed for the entire cohort and for 2 patient groups depending on whether an oxygenator was used in the bypass circuit (166 patients; 58%) or not (119 patients; 42%).


RESULTS
Early failure (including death and takedown) occurred in 7 patients (2.5%). Prevalence of new early postoperative sinus node dysfunction necessitating a permanent pacemaker was 0.4%, and that of new tachyarrhythmias necessitating discharge home on a regimen of antiarrhythmia medications was 2.5%. Ten-year actuarial freedom from Fontan failure, new sinus node dysfunction necessitating a permanent pacemaker, and reoperation for conduit thrombosis or stenosis was 90%, 96%, and 98%, respectively. Fenestration rate was lower (P = .001) in the no-oxygenator group (8%) than in the oxygenator group (25%). Patients in the no-oxygenator group had lower intraoperative Fontan pressure (12.0 +/- 2.3 vs 13.5 +/- 2.4 mm Hg, P < .001), common atrial pressure (4.6 +/- 1.8 vs 5.3 +/- 1.8 mm Hg, P = .003), and transpulmonary gradient (7.5 +/- 2.1 vs 8.3 +/- 2.2 mm Hg, P = .013) than did the oxygenator group.


CONCLUSIONS
The extracardiac conduit Fontan operation coupled with minimal use of extracorporeal circulation is associated with favorable intraoperative hemodynamics, low fenestration rate, minimal risk of thrombosis or stenosis, and minimal early and late rhythm disturbance.
Petrossian
Ed
E
Division of Pediatric Cardiac Surgery, Stanford University School of Medicine, Stanford, Calif, USA. epetrossian@childrenscentralcal.org
Reddy
V Mohan
VM
Collins
Kathryn K
KK
Culbertson
Casey B
CB
MacDonald
Malcolm J
MJ
Lamberti
John J
JJ
Reinhartz
Olaf
O
Mainwaring
Richard D
RD
Francis
Paul D
PD
Malhotra
Sunil P
SP
Gremmels
David B
DB
Suleman
Sam
S
Hanley
Frank L
FL
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D010106:Oxygenators; D012189:Retrospective Studies; D016896:Treatment Outcome