title: Outcomes of the Fontan procedure using cardiopulmonary bypass with aortic cross-clamping.
abstract: BACKGROUND
  Avoidance of cardiopulmonary bypass (CPB) and aortic cross-clamping during the Fontan procedure has been advocated to improve outcomes. We continue to use CPB with aortic cross-clamping for the Fontan procedure.
  
  
  METHODS
  We performed a review of patients undergoing the Fontan procedure between January 1, 2000 and December 31, 2004.
  
  
  RESULTS
  The Fontan procedure was performed in 160 patients. The median age was 2.2 years (range, 1.0 to 29.1 years). Hypoplastic left heart syndrome or a variant was present in 114 patients (71%), and heterotaxy was present in 19 (12%). CPB and modified ultrafiltration were used in all patients. Aortic cross-clamping was used in 154 (96%) of 160 patients and deep hypothermic circulatory arrest (DHCA) in 132 (83%). A lateral tunnel Fontan was performed in 69 patients (43%) and an extracardiac Fontan in 91 (57%). A fenestration was created in 144 patients (90%). Two patients died. Freedom from death or takedown was 98% (157/160). Median duration of pleural drainage was 2 days (range, 1 to 44 days) and was more than 14 days in 16 patients. Median duration of hospitalization was 6 days (range, 3 to 55 days). The small number of deaths precluded assessment of risk factors for mortality. By multivariable analysis, risk factors for pleural drainage longer than 3 days were extracardiac connection (p < 0.001) and increasing mean pulmonary artery pressure before the Fontan procedure (p = 0.033). By multivariable analysis, risk factors for hospitalization for more than 7 days were extracardiac connection (p = 0.003), increasing duration of total support (CPB and DHCA, p = 0.027), and decreasing systemic oxygen saturation before the Fontan procedure (p = 0.048).
  
  
  CONCLUSIONS
  The Fontan procedure can be performed using CPB and aortic cross-clamping with low morbidity and mortality.
authors.affiliation: Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Meyer
authors.forename: Guillermo
authors.initials: G
authors.lastname: Zamora
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ittenbach
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Sarah
authors.initials: S
authors.lastname: Tabbutt
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gruber
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D003250:Constriction; D018729:Fontan Procedure / Q000401:mortality; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D016896:Treatment Outcome