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The Fontan-operation: from intra- to extracardiac procedure
W Kuroczynski1, C Kampmann, Y-H Choi
1Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University, Langenbeckstrasse 1, D-55131 Mainz, Germany. kuroczynski@uni-mainz.de
Insights
Modified Fontan operations, including extracardiac conduits, offer effective palliation for univentricular heart disease with no perioperative mortality. These procedures improve arterial oxygen saturation and offer surgical advantages.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- The Fontan operation is the standard palliative treatment for univentricular heart disease.
- Arrhythmias are a significant concern following intra-atrial lateral tunnel Fontan procedures.
Purpose of the Study:
- To evaluate the outcomes of modified Fontan operations, comparing intracardiac tunnels with extracardiac conduits.
- To assess the impact of fenestrations on arterial oxygen saturation post-Fontan.
Main Methods:
- A cohort of 46 children underwent Fontan-type operations between January 1995 and April 2002.
- Patients were divided into two groups: intracardiac tunnel (n=33) and extracardiac conduit (n=13), with or without fenestration.
- Procedures were performed in normothermia on a beating heart.
Main Results:
- No perioperative mortality was observed in either group.
- Significant postoperative increases in arterial oxygen saturation were noted, ranging from 86% to 90.5%.
- Fenestrated procedures showed saturation reaching 90% after fenestration closure.
Conclusions:
- Modified Fontan operations, including the extracardiac conduit technique, are safe and effective.
- The extracardiac conduit Fontan procedure offers advantages such as reduced surgical injury and enhanced intraoperative flexibility.
- These modified approaches improve oxygenation in patients with univentricular hearts.
Purpose:
For treatment of univentricular heart, the Fontan operation has been established as the definitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atrial lateral tunnel Fontan operation.
Methods:
From January 1995 until April 2002, 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed.
Principal Findings:
There was no perioperative mortality. All patients showed postoperative a significant increase of arterial oxygen saturation, from 76 to 86% after surgery with fenestration, or to 90.5% without fenestration respectively. In patients with fenestration procedure, the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation.
Conclusions:
Modified Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the benefits of less surgical injury and a higher intraoperative flexibility.
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