title: Outcomes of the extracardiac fontan procedure using cardıopulmonary bypass: early results.
abstract: BACKGROUND
  Although the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.
  
  
  METHODS
  Between September 2011 and April 2013, 9 consecutive patients (3 males and 6 females) underwent extracardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon. The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the inferior vena cava and right pulmonary artery.
  
  
  RESULTS
  The mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged without complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventilation within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ± 1.9 days, respectively.
  
  
  CONCLUSIONS
  The extracardiac Fontan operation performed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favorable postoperative hemodynamics and morbidity rates.
authors.affiliation: Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ugurlucan
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Eylem Yayla
authors.initials: EY
authors.lastname: Tuncer
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Fusun
authors.initials: F
authors.lastname: Guzelmeric
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Eylul
authors.initials: E
authors.lastname: Kafali
authors.affiliation: Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
authors.forename: Omer Ali
authors.initials: OA
authors.lastname: Sayin
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nihat
authors.initials: N
authors.lastname: Cine
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Naci
authors.initials: N
authors.lastname: Oner
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Yildirim
authors.affiliation: Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ceyran
authors.affiliation: Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey Department of Cardiovascular Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Basaran
mesh_terms: D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D018729:Fontan Procedure / Q000145:classification / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D016896:Treatment Outcome