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Modified Fontan without use of cardiopulmonary bypass
V K Tam1, B E Miller, K Murphy
1Department of Anesthesiology, Emory University School of Medicine, and Sibley Heart Center, Egleston Children's Hospital, Atlanta, Georgia, USA.
Background:
Direct cavopulmonary connection using an extracardiac conduit has a number of theoretical advantages in the staged management of children with single ventricular congenital heart defects. With appropriate planning, completion Fontan using an extracardiac connection may be accomplished without the use of cardiopulmonary bypass.
Methods:
From January 1995 to October 1997, 32 consecutive patients underwent completion Fontan using an extracardiac cavopulmonary connection. Twenty-one of these patients had completion Fontan without the use of cardiopulmonary bypass (No CPB group). Their postoperative outcome was retrospectively compared with a second group of 11 patients who underwent completion Fontan with an extracardiac conduit with the use of cardiopulmonary bypass.
Results:
There was no operative or hospital mortality in either group. Early postoperative hemodynamics appear to be significantly improved in the No CPB group. Transfusion of cryoprecipitate and platelets was significantly less in the group without the use of cardiopulmonary bypass (p = 0.026, p < 0.001, respectively). Review of the most recent 12 patients also demonstrated a substantially shorter extubation time and intensive care unit stay. The length of hospital stay was significantly shorter (p = 0.036).
Conclusions:
Completion Fontan without the use of cardiopulmonary bypass results in improved immediate postoperative hemodynamics, and decreased use of blood and blood products. The most recent group appears to demonstrate a more rapid recovery time and shorter hospital stay (p = 0.036).