title: Novel method of surgical preparation for transcatheter completion of Fontan circulation: creation of an extracardiac pathway.
abstract: BACKGROUND
  The alliance between surgeons and interventionists has inspired creative techniques to surgically precondition the heart for subsequent transcatheter repair. The interest stems from the need to avoid repeated surgeries. Transcatheter Fontan completion of intracardiac pathway has been reported.
  
  
  OBJECTIVE
  To report a new surgical preparation for transcatheter completion of extracardiac Fontan circulation.
  
  
  METHODS
  The inferior vena cava (IVC) was cut and anastomosed end-to-end with the inferior end of a Gore-Tex conduit in 20 lambs. A ring was placed around the IVC near the anastomosis. The superior vena cava was cut and connected with the right atrium (RA) auricle. In group 1 (n=9), the Gore-Tex conduit was occluded at both ends by a polytetrafluoroethylene membrane. In group 2 (n=11), the upper segment of the Gore-Tex tube was opened and connected to the RA to allow free flow of IVC blood. Fontan completion was attempted 1-3 months following surgery. Animals were sacrificed just after or 3 months after completion.
  
  
  RESULTS
  All lambs were successfully preconditioned. We failed to complete the pathway in all animals from group 1 - autopsy showed occlusion of the pathway. In group 2, there was one postoperative death, one elective sacrifice after 2 months to assess pathway integrity, and nine successful completions. Autopsies showed widely patent pathway and well-deployed covered stents completely occluding the fenestrations.
  
  
  CONCLUSIONS
  Circulating extracardiac conduit offers the best option to prepare for extracardiac Fontan completion. This surgical preparation opens new frontiers for transcatheter and hybrid techniques for extracardiac Fontan completion.
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: younes.boudjemline@nck.aphp.fr.
authors: Younes
authors: Y
authors: Boudjemline
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Sophie
authors: S
authors: Malekzadeh-Milani
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Mathieu
authors: M
authors: Van Steenberghe
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Yann
authors: Y
authors: Bögli
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Mehul
authors: M
authors: Patel
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Regis
authors: R
authors: Gaudin
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors: Damien
authors: D
authors: Bonnet
authors: Pediatric cardiology, centre de référence des malformations cardiaques congénitales complexes-M3C, Necker hospital for sick children, Assistance publique des Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris cedex, France.
authors: Sébastien
authors: S
authors: Gerelli
mesh_terms: D000818:Animals; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D018729:Fontan Procedure / Q000379:methods*; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006439:Hemodynamics; D023421:Models, Animal; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D012756:Sheep; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000503:physiopathology / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene
keywords: Approches hybrides; Cardiopathies congénitales; Circulation de Fontan; Congenital heart defect; Fontan circulation; Hybrid approaches; Techniques percutanées; Transcatheter technique