Late results of extracardiac Fontan repair

The Fontan procedure by means of an extracardiac conduit was initially proposed for patients presenting with anomalies of intra-atrial anatomy. We extended this technique to all patients with functional anatomic single ventricle. Between 1988 and 1998, 206 patients with complex cardiacanomalies underwent a total extracardiac cavopuolmonary connection. In 202 patients we used a conduit, in 4 patients we performed an IVC to pulmonary artery direct anastomosis. Ten patients underwent Conversion of a filing atriopulmonary Fontan procedure to a total extracardiac cavopulmonary connection. Early deaths occurred in 10% of patients and the extracardiac conduit was taken down in 3 additional patients. The cause of death was myocardial failure in 13 patients. Pulmonary distortion or hypoplasia in 6. No deaths have occurred in our last 45 patients. We observed no cases of conduit obstruction and thrombosis. Arrthymias were present in 16 patients. Ten patients underwent conversion of a formed modified Fontan. There were no immediate postoperative deaths. These results demonstrate that the total extracardiac cavopulmonary connection provide good early and mildterm results and is the technique of choice for a Fontan type repair. Copyright 1999 by W.B. Saunders Company