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Seven-year clinical experience with the extracardiac pedicled pericardial Fontan operation
Minoo N Kavarana1, Sebastian Pagni, Michael R Recto
1Division of Thoracic and Cardiovascular Surgery, Kosair Children's Hospital, University of Louisville, Louisville, Kentucky, USA. mkavarana@att.net
Insights
The extracardiac pedicled pericardial Fontan (EPPF) operation shows midterm outcomes comparable to other Fontan techniques. While no clear advantage is yet demonstrated, its low complication rate and growth potential are promising for pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Cardiovascular Surgery
Background:
- The extracardiac pedicled pericardial Fontan (EPPF) operation is a surgical technique for complex single-ventricle physiology.
- Previous suggestions of improved outcomes and growth potential with EPPF have not been definitively proven.
Purpose of the Study:
- To evaluate the midterm outcomes of the extracardiac pedicled pericardial Fontan operation.
- To assess the safety and efficacy of EPPF in pediatric patients.
Main Methods:
- Retrospective review of 54 consecutive patients undergoing EPPF between June 1996 and August 2003.
- Yearly clinical and echocardiographic follow-up with a mean follow-up of 2.8 years.
Main Results:
- Low mortality (1.8%) and reoperation rates (1.8%).
- High freedom from thromboembolic events (96.2%) and death (100%) at 2.8 years.
- Excellent ventricular function, flow dynamics, and functional class (NYHA I-II) in all patients.
Conclusions:
- EPPF demonstrates midterm outcomes comparable to other Fontan techniques.
- The procedure exhibits a low complication rate and potential for growth, making it an appealing option.
- Further follow-up is needed to determine if EPPF superiority can be established.
Background:
Although improved perioperative outcomes with growth potential of the extracardiac pedicled pericardial Fontan (EPPF) operation have been suggested, no advantage has been demonstrated.
Methods:
We retrospectively reviewed our institutional experience of 54 consecutive patients undergoing EPPF between June 1996 and August 2003. Clinical and echocardiographic follow-up was obtained yearly with a mean follow-up of 2.8 +/- 2.0 years.
Results:
There were 29 males, median age 3.3 years (2-6.8). Median cardiopulmonary bypass time was 79 min (39-295). Fibrillatory arrest was used briefly in 9 patients, of which 6 were for fenestration. One Fontan required takedown (1.8%) and there was 1 death (1.8%) from Candida mediastinitis. Median intensive care unit stay, hospital length of stay, and chest tube drainage were 4 days, 12 days, and 8 days, respectively. Arrhythmias occurred in 7 patients. Three (5.6%) of these had preexisting Holter abnormalities requiring permanent pacemaker implantation. Freedom from thromboembolic events, reoperation, and death at 2.8 years after discharge were 96.2%, 98.1%, and 100%, respectively. All patients were New York Heart Association class I-II, with median oxygen saturation of 94 %. Only 5 patients (9.4%) had mild self-restricted activities. Echocardiographic evaluation revealed excellent ventricular function and flow dynamics.
Conclusions:
At midterm follow-up this technique yields outcomes as good as the other Fontan techniques and with further follow-up may prove to be superior. However, at this point no clear advantage has been demonstrated. The low rate of complications and potential for growth are appealing features of this procedure.
