Fontan completion: intracardiac tunnel or extracardiac conduit?

The concept of Fontan circulation was first clinically introduced in 1971. Since that time, many technical modifications have been advocated. Among them, the concept of total cavopulmonary connection, introduced in the late 80's, has experienced widespread use over the past 10 years. In this procedure, a bidirectional superior cavopulmonary anastomosis is performed while the inferior caval blood flow is directed towards the pulmonary arteries through an intraatrial composite tunnel. More recently, an extracardiac conduit to divert inferior vena cava flow to the pulmonary arteries has been advocated. The respective merits of these two approaches remain to be determined.