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Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison
S Prathap Kumar1, Catherine S Rubinstein, Janet M Simsic
1Division of Cardiothoracic Surgery, Pediatric Cardiology, Medical University of South Carolina, Charelston, USA.
The Annals of Thoracic Surgery
|November 7, 2003
Summary
The lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures show similar survival and functional outcomes. Extracardiac conduit Fontan surgery had a higher early incidence of sinus node dysfunction.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
- Two common surgical techniques are the lateral tunnel (LT) and extracardiac conduit (ECC) methods.
- Comparing outcomes of LT and ECC Fontan procedures is crucial for surgical decision-making.
Purpose of the Study:
- To compare the early and mid-term outcomes of lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures.
- To evaluate operative mortality, morbidity, resource utilization, and long-term functional status.
- To identify differences in postoperative complications, specifically sinus node dysfunction.
Main Methods:
- A retrospective review of 70 Fontan procedures (37 LT, 33 ECC) performed between November 1995 and October 2002.
- All procedures were fenestrated and 96% were staged with a prior superior cavopulmonary connection.
- Patient characteristics, operative details, and postoperative outcomes including survival and functional status were analyzed.
Main Results:
- Operative mortality was similar (2.8%) between LT and ECC groups.
- Early postoperative hemodynamics, mechanical ventilation duration, ICU stay, drainage, and hospital stay did not differ significantly.
- Extracardiac conduit (ECC) patients showed a higher incidence of early sinus node dysfunction (27% vs. 8% in LT).
- Mid-term follow-up revealed comparable survival (5-year: 97% LT vs. 91% ECC) and functional status (NYHA class I/II).
Conclusions:
- Both lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures offer comparable early and mid-term survival and functional outcomes.
- Extracardiac conduit (ECC) surgery is associated with a higher incidence of early sinus node dysfunction compared to the lateral tunnel (LT) approach.
- The choice between LT and ECC may depend on patient-specific factors and the surgeon's experience, with careful consideration of potential arrhythmias.
