title: Open anastomosis of extracardiac conduit for total cavopulmonary connection decreases post-operative pleural effusion.
abstract: OBJECTIVE
  The goal of this study was to see whether the open anastomosis technique using vacuum-assisted venous drainage at the time of the Fontan procedure was associated with decreased post-operative pleural effusion.
  
  
  METHODS
  We analysed a subgroup of patients with a functional single ventricle who underwent non-fenestrated total cavopulmonary connection completion with the insertion of an extracardiac conduit as the sole or predominant procedure conducted by a single surgeon at a single institute, using either an open or closed anastomosis technique.
  
  
  RESULTS
  Median age and weight were 2.3 years, with a range from 1.3 to 27.6 years and 11.4 kilograms, with a range from 9.7 to 43 kilograms, respectively. The open anastomosis technique was associated with a shorter bypass run (p = 0.015), decreased surgical duration (p = 0.032), fewer pleural effusion days (p = 0.049), and lesser pleural effusion (p = 0.013) than closed anastomosis. Correlation analysis demonstrated a significant relationship between the amount of pleural effusion and surgical duration (correlation efficient, 0.535; p = 0.033). A logistic regression model showed that the open technique was associated with a 20-fold increase in the likelihood of having a total chest tube discharge of less than 300 millilitres (p = 0.027).
  
  
  CONCLUSIONS
  The open anastomosis technique shortens operative duration and bypass run, which in turn might contribute to decreased pleural effusion soon after the modified Fontan procedure.
authors.affiliation: Department of Surgery, Keio University, Tokyo, Japan. aebajp@gmail.com
authors.forename: Ryo
authors.initials: R
authors.lastname: Aeba
authors.forename: Masanori
authors.initials: M
authors.lastname: Morita
authors.forename: Toru
authors.initials: T
authors.lastname: Matayoshi
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yozu
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D055815:Young Adult