Extracardiac conduit fontan procedure: early and intermediate results

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Hemodynamics

Background:

• The extracardiac Fontan procedure aims to optimize ventricular and pulmonary vascular function.
• It seeks to improve upon classic atriopulmonary connections by maximizing laminar flow and minimizing cardiac manipulation.
• Key goals include avoiding intra-atrial suture lines and reducing cardiopulmonary bypass time.

Purpose of the Study:

• To assess the clinical results of the extracardiac Fontan procedure.
• To compare its efficacy against classic atriopulmonary connections in patients with univentricular physiology.
• To evaluate the impact on ventricular and pulmonary vascular function.

Main Methods:

• A cohort of 45 patients with univentricular physiology underwent the extracardiac Fontan procedure between 1990 and 1997.
• The median age was 4.0 years, with diagnoses including tricuspid atresia, double-inlet left ventricle, and complex anomalies.
• Eighty-two percent of procedures were staged, and 89% of patients were in sinus rhythm preoperatively.

Main Results:

• Median cardiopulmonary bypass time was significantly reduced, especially in later cases.
• Low intraoperative Fontan pressures and transpulmonary gradients were observed.
• No early or late mortality occurred. At median follow-up, 87% were in NYHA class I, with improved arterial oxygen saturation from 82% to 97%.

Conclusions:

• The extracardiac Fontan procedure, particularly when staged, yields excellent early and midterm clinical results.
• It significantly improves quality of life, maintains sinus rhythm, and preserves ventricular function.
• Staged procedures demonstrated superior functional class, sinus rhythm maintenance, and ventricular function preservation.