title: Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure.
abstract: OBJECTIVE
  Factors related to prolonged pleural drainage after the Fontan operation have not been clearly defined. We investigated perioperative variables to establish factors predicting operative morbidity including prolonged chest tube drainage. Also, we pursued the fate of the fenestration during the follow-up period.
  
  
  METHODS
  We retrospectively reviewed 52 patients who had undergone a fenestrated extracardiac Fontan procedure between August 1998 and June 2008. The median age at the time of surgery was 34.8 (range: 18.5 ∼ 156) months and the median body weight 13.2 kg (range: 9.5 ∼ 33). A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables for postoperative morbidity.
  
  
  RESULTS
  Operative mortality occurred in one patient (1.9%). The mean duration of respiratory support, chest tube drainage, and hospital stay was 13 hours (range: 4 to 328 hours), six days (range: 2 to 45 days), and 16 days (range: 7 to 444 days), respectively. Statistically, an operation without previous bidirectional cavopulmonary shunt (OR 30, 95% CI 3.1 to 289) was the only independent risk factor for prolonged pleural drainage. Aortic cross-clamp time was identified as a risk factor for prolonged mechanical ventilatory support. During a median follow-up at 62 months (range: 17 to 137 months), there was one late death (1.9%). Twenty-two patients (43%) underwent intervention for fenestration closure.
  
  
  CONCLUSIONS
  Previous bidirectional cavopulmonary shunt and shortened aortic cross-clamp time may reduce postoperative morbidity including prolonged chest tube drainage and mechanical ventilator support after the fenestrated extracardiac conduit Fontan procedure.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Su Wan
authors.initials: SW
authors.lastname: Kim
authors.forename: Tae-Gook
authors.initials: TG
authors.lastname: Jun
authors.forename: Ji-Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Pyo Won
authors.initials: PW
authors.lastname: Park
authors.forename: I-Seok
authors.initials: IS
authors.lastname: Kang
authors.forename: June
authors.initials: J
authors.lastname: Huh
authors.forename: June
authors.initials: J
authors.lastname: Hurh
authors.forename: Heung-Jae
authors.initials: HJ
authors.lastname: Lee
mesh_terms: D000714:Anastomosis, Surgical; D006328:Cardiac Catheterization; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity / Q000639:trends; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome