Hybrid management strategy for percutaneous Fontan completion without surgery: early results.
BACKGROUND
We report early results of surgical preparation and subsequent percutaneous Fontan completion strategy for the treatment of single-ventricle defects.


METHODS
Two hundred twenty-seven patients underwent bidirectional cavopulmonary connection (BDCPC) between 2002 and 2007. Thirty-four patients had lateral tunnel created at time of BDCPC, fenestrated with 10 to 14 mm openings with the cardiac superior vena cava end patched to maintain BDCPC physiology. At second stage, Fontan circulation was established by superior vena cava patch perforation, tunnel dilatation, and stenting plus fenestration device closure.


RESULTS
Thirty-four patients underwent Fontan preparation with BDCPC. Median age was 7.7 months (5 to 51) and 29 patients (85%) had previous palliation. Mean bypass and ischemic times were 141 and 72 minutes, respectively. Median ventilation, intensive care, and hospital stay durations were 1, 5, and 10 days, respectively. There was one early death and two take-downs. Twenty-eight patients underwent Fontan procedure: surgical (n = 3), percutaneous (n = 25). None of the patients who underwent percutaneous Fontan completion required inotropes, chest tube insertion, or mechanical ventilation. Median intensive care and hospital stay durations were 1 and 6 days, respectively. There were no early mortalities after percutaneous Fontan but one late death and one surgical revision. Overall survival after BDCPC with Fontan preparation was 77%.


CONCLUSIONS
Despite longer bypass and ischemic times, Fontan preparation at time of BDCPC is feasible and associated with encouraging early outcomes. Percutaneous Fontan completion is associated with short recovery, low morbidity and excellent early dynamics, and echocardiographic and clinical outcomes. Further follow-up is needed to confirm those favorable results.
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. balsoufi@hotmail.com
Bahaaldin
B
Alsoufi
Fadel
F
Alfadley
Ahmad
A
Al-Omrani
Abid
A
Awan
Mamdouh
M
Al-Ahmadi
Majid
M
Al-Fayyadh
Zohair
Z
Al-Halees
Charles C
CC
Canver
D000015:Abnormalities, Multiple / Q000601:surgery; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*