Univentricular repair: is routine fenestration justified?

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The Fontan-type repair is a critical surgical procedure for hearts with a functional single ventricle.
• Baffle fenestration has emerged as a promising modification to improve outcomes.
• This study evaluates the impact of fenestration on univentricular repair outcomes.

Purpose of the Study:

• To assess the impact of atrial baffle fenestration on the outcome of univentricular repairs.
• To determine if fenestration influences Fontan failure rates and postoperative complications.
• To analyze risk factors associated with Fontan repair outcomes.

Main Methods:

• A retrospective analysis of 348 patients undergoing univentricular repair from 1988 to 1997.
• Comparison between patients with and without routine atrial baffle fenestration (introduced in 1994).
• Evaluation of Fontan failure rates, pleural effusions, survival, and functional status.

Main Results:

• The overall Fontan failure rate was 14%, with absence of fenestration being a significant predictor (RR 3.3).
• Absence of fenestration (RR 3.97) and prolonged aortic cross-clamp time were risk factors for complications.
• Actuarial survival at 90 months was 81%, with 90% of patients in NYHA class I. Fenestrated group had mean O2 saturation of 89%.

Conclusions:

• Elective fenestration of the intraatrial baffle is associated with decreased Fontan failure rates.
• Fenestration also reduces the occurrence of significant postoperative pleural effusions.
• Routine elective fenestration may be justified in all univentricular repairs.