Comparison of fenestrated and nonfenestrated patients undergoing extracardiac Fontan.
BACKGROUND
The purpose of this study is to compare morbidity and mortality between fenestrated (F, 61 patients) and nonfenestrated (NF, 54 patients) extracardiac Fontan patients during two eras from July 1995 to December 2010: era 1(1995 to 2004) and era 2 (2005 to 2010).


METHODS
Variables evaluated included morphology, hemodynamics, chest tube volume and duration, intensive care and hospital stay, oxygen saturation, neurologic events, rhythm, and readmissions for chylous effusions. Follow-up in 114 hospital survivors was longer in the nonfenestrated cohort (F, 5.0 ± 3.3 years; NF, 7.1 ± 4.6 years; p < 0.005).


RESULTS
Cohorts were similar in body size, morphology, and hemodynamics. Fenestration in hypoplastic left heart syndrome was appreciatively higher in era 2. Bypass time (F, 69 ± 27 minutes; NF, 57 ± 21 minutes) and conduit size (F, 18.8 mm; NF, 19.1 mm) were similar. There was 1 early nonfenestrated Fontan death (1 of 54; 2%) and 4 late deaths (F, 2 of 61, 5%; NF, 2 of 53, 4%; p = 0.86). Room air saturation was higher in NF patients (F, 89%; NF, 94%; p < 0.05). Total chest tube volume was similar, but fenestration was associated with greater chest tube drainage among hypoplastic left heart patients (HLHS, 5,582 ± 3,286 mL; non-HLHS, 3,405 ± 2,533 mL; p = 0.06; odds ratio; 2.0). Readmission to treat chylous effusions, loss of sinus rhythm, actuarial freedom from death, all neurologic events, pacemaker insertion, and Fontan takedown were similar in both cohorts.


CONCLUSIONS
Fenestration was associated with lower discharge oxygen saturations, but late outcomes in fenestrated and nonfenestrated patients are equivalent.
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri. Electronic address: fiorem2@slu.edu.
Andrew C
AC
Fiore
Division of Cardiothoracic Surgery, Indiana University School of Medicine, James Whitcomb Riley Children's Hospital, Indianapolis, Indiana.
Corinne
C
Tan
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Eric
E
Armbrecht
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Charles B
CB
Huddleston
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Eric
E
Kim
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Nicholas
N
Goel
Division of Cardiothoracic Surgery, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Connor
C
McCartney
Division of Cardiothoracic Surgery, Indiana University School of Medicine, James Whitcomb Riley Children's Hospital, Indianapolis, Indiana.
Parth
P
Patel
Division of Cardiothoracic Surgery, Indiana University School of Medicine, James Whitcomb Riley Children's Hospital, Indianapolis, Indiana.
John W
JW
Brown
D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome