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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
08:50

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Interventions associated with minimal fontan mortality

G S Van Arsdell1, B W McCrindle, K D Einarson

  • 1Division of Cardiovascular Surgery, The Hospital for Sick Children and the University of Toronto, Ontario, Canada. glen.vanarsdell@sickkids.on.ca

The Annals of Thoracic Surgery
|September 2, 2000
PubMed

Insights

The Fontan procedure

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Congenital Heart Disease

Background:

  • The Fontan procedure is a complex surgical intervention for congenital heart defects.
  • Initial operative mortality rates were high (15%) but improved significantly over time.

Purpose of the Study:

  • To investigate factors associated with the observed decline in Fontan procedure mortality.
  • To identify interventions contributing to improved patient outcomes.

Main Methods:

  • Retrospective review of 100 consecutive Fontan procedure cases.
  • Comparison of patient characteristics and perioperative management between early and later cohorts.

Main Results:

  • Mortality decreased from 16% to 0% between the first and second 50 patients.
  • Increased use of extracardiac Fontan, prior cavopulmonary anastomosis, shorter bypass times, magnesium-rich cardioplegia, and post-bypass ultrafiltration were noted in the lower-mortality group.
  • No significant differences in patient age, diagnosis, or surgeon were found.

Conclusions:

  • Patient factors did not explain the mortality reduction.
  • Specific surgical techniques and perioperative management strategies, including extracardiac Fontan and modified ultrafiltration, are linked to reduced mortality.
  • These interventions may enhance postoperative myocardial function.
Abstract

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