title: Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience.
abstract: OBJECTIVE
  The use of modified extracardiac Fontan operation (ECFO) for total cavo-pulmonary connection allows cardiopulmonary bypass (CPB) to be avoided and seems to improve early postoperative results. We evaluated our experience with the off-pump technique for ECFO.
  
  
  METHODS
  Since 2009, the last 17 consecutive patients of 137 (median age 3.2 years, median weight 14.5 kg) in whom no intracardiac surgery was necessary underwent ECFO without CPB. The non-fenestrated graft was connected end-to-side to the pulmonary artery without bypass; subsequently temporary passive inferior vena cava (IVC)-to-atrial bypass was used for the anastomosis between IVC and graft. The perioperative and postoperative course was compared between consecutive paediatric patients operated on using the CPB vs off-pump technique.
  
  
  RESULTS
  There was no mortality in the off-pump group, with a total early mortality of 3.0%. Overall operation time for the Fontan operation using the off-pump technique was significantly reduced (160 vs 200 min, P < 0.001). The median Fontan pressure 24 and 48 h postoperatively was significantly lower in the off-pump group (P = 0.002/0.042). Duration of mechanical ventilation (9 vs 14 h, P = 0.016), pleural effusions (4 vs 8 days, P < 0.001) as well as the median intensive care unit (2 vs 4 days, P = 0.013) and hospital stay (median 10 vs 15 days, P < 0.001) was significantly shorter in patients who underwent the off-pump Fontan operation. The necessity of blood transfusions was significantly reduced with the off-pump in comparison with the on-pump technique (14 of 17 vs 34 of 84 patients, P = 0.003).
  
  
  CONCLUSIONS
  The ECFO without CPB is an established low-risk surgical procedure that improves the early postoperative course and significantly reduces the use of blood products and the duration of pleural effusions in selected patients.
authors.affiliation: Department of Congenital Heart Diseases, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany. ovroutski@dhzb.de
authors.forename: Stanislav
authors.initials: S
authors.lastname: Ovroutski
authors.forename: Christian
authors.initials: C
authors.lastname: Sohn
authors.forename: Oliver
authors.initials: O
authors.lastname: Miera
authors.forename: Björn
authors.initials: B
authors.lastname: Peters
authors.forename: Vladimir
authors.initials: V
authors.lastname: Alexi-Meskishvili
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D059035:Perioperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins