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Optimal conduit size for extracardiac Fontan operation.
V Alexi-Meskishvili1, S Ovroutski, P Ewert
1Department of Cardiovascular and Thoracic Surgery, German Heart Institute (Deutsches Herzzentrum Berlin), Berlin, Germany. alexi@dhzb.de
Summary
Optimizing extracardiac Fontan conduit size before surgery is crucial. Studies suggest implanting near-adult sized conduits in children aged 2-3 years to improve outcomes and prevent thrombosis.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Vascular Grafting
Background:
- Extracardiac Fontan operation (ECFO) faces challenges with conduit growth and thrombosis.
- Optimal conduit sizing for ECFO remains undetermined, impacting patient outcomes.
Purpose of the Study:
- To determine if optimal extracardiac conduit dimensions can be established pre-ECFO.
- To correlate patient factors with conduit size for improved Fontan circulation.
Main Methods:
- Compared actual/expected inferior vena cava (IVC) diameters with conduit size in 20 post-ECFO patients.
- Measured IVC-right pulmonary artery (RPA) distance in 50 pediatric/adult patients.
- Analyzed cases of conduit thrombosis in relation to conduit size and hemodynamics.
Main Results:
- IVC diameter showed weak correlation with anthropometrics and expected values.
- IVC-RPA distance correlated with height but was variable; reached 60-80% adult values by age 2-4 years/12-15 kg.
- Conduit thrombosis occurred in two patients with oversized conduits and poor Fontan hemodynamics.
Conclusions:
- ECFO can be performed at 2-3 years/12-15 kg with an almost adult-sized conduit, optimizing hemodynamics.
- Conduit optimization requires assessment of actual IVC diameter and IVC-RPA distance.
- Postoperative anticoagulation is recommended for patients with suboptimal circulation to prevent thrombosis.