title: Systemic right ventricular morphology in the early postoperative course after extracardiac Fontan operation: is there still a need for special care?
abstract: We aimed to compare early postoperative outcome after extracardiac (EC) Fontan operation between patients with right (RV) or left (LV) systemic ventricles.
  
  
  
  In total, 173 consecutive patients (median age 4 years, median weight 14 kg) underwent EC Fontan between 1995 and 2013. Pre- and intraoperative data as well as detailed postoperative haemodynamic variables were compared between patients with LV [ n  = 109 (63%)] and RV [ n  = 64 (37%)].
  
  
  
  : RV patients showed significantly lower mean arterial (median 55 vs 59 mmHg, P  = 0.04), higher atrial (median 8 vs 6 mmHg, P  = 0.03) and comparable pulmonary pressure (median 14 vs 14 mmHg, P  = 0.7) as well as lower mean systemic perfusion pressure (median 39 vs 43 mmHg, P  = 0.03) on Day 0 after EC Fontan. They suffered from longer intubation time (median 18 vs 12 h, P  = 0.008), higher incidence of ascites (46% vs 28%, P  = 0.04) and need for dialysis (21% vs 4%, P  = 0.003). Prolonged inotropic support (25% vs 8%, P  = 0.02) and pharmacological treatment to reduce pulmonary vascular resistance (71% vs 53%, P  = 0.002) were more often used in RV patients and they showed more often supraventricular tachyarrhythmia (27% vs 5%, P  < 0.001) and a longer intensive care unit-stay (median 4 vs 3 days, P  = 0.03). However, early mortality, need for Fontan takedown, use of mechanical circulatory support, pleural effusions and hospital stay were not significantly different between both groups.
  
  
  
  Patients with systemic RV demonstrate higher morbidity in the early postoperative course compared with patients with systemic LV anatomy and require intensified postoperative management to avoid postoperative Fontan failure.
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nordmeyer
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Rohder
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Nordmeyer
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Miera
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Peters
authors.affiliation: Department of Surgery for Congenital Heart Disease/Paediatric Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Mi-Young
authors.initials: MY
authors.lastname: Cho
authors.affiliation: Department of Surgery for Congenital Heart Disease/Paediatric Cardiac Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Photiadis
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.affiliation: Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Stanislav
authors.initials: S
authors.lastname: Ovroutski
mesh_terms: D000293:Adolescent; D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents
keywords: Extracardiac Fontan; Inotropic support; Systemic right ventricle