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Aortopulmonary collateral flow in the Fontan patient: does it matter?

S M Bradley1, M M McCall, J J Sistino

  • 1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425, USA. bradlesm@musc.edu

The Annals of Thoracic Surgery
|August 23, 2001
PubMed

Insights

Aortopulmonary collaterals (APCs) are common in Fontan procedures. However, the extent of APC flow does not significantly impact the outcomes of the Fontan procedure in well-prepared patients.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The impact of aortopulmonary collaterals (APCs) on Fontan procedure outcomes remains uncertain.
  • Understanding APCs is crucial for optimizing Fontan procedure results.

Purpose of the Study:

  • To determine the incidence and extent of APC flow in Fontan procedure patients.
  • To identify risk factors associated with APC flow.
  • To assess the effect of APC flow on Fontan procedure outcomes.

Main Methods:

  • Directly measured APC flow in 32 patients during Fontan procedures.
  • Expressed APC flow as a percentage of total cardiopulmonary bypass pump flow.
  • Data collected between July 1997 and September 2000.

Main Results:

  • APC flow varied widely, from 9% to 49% (median 18%) of total pump flow.
  • Higher preoperative oxygen saturation and pulmonary-to-systemic flow ratio correlated with increased APC flow.
  • No significant effect of APC flow on postoperative pressures, effusions, or resource utilization was observed.

Conclusions:

  • APC flow is consistently present in patients undergoing Fontan procedures, with significant variability.
  • Increased APC flow did not adversely affect the outcomes of the Fontan procedure in this cohort.
  • Findings are applicable to well-prepared patients; results may differ in higher-risk individuals.
Abstract

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