Extracardiac Fontan operation without cardiopulmonary bypass

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Cardiovascular Surgery

Background:

• Single ventricle physiology presents surgical challenges.
• Cardiopulmonary bypass and aortic cross-clamping can negatively impact ventricular and pulmonary function.
• Minimally invasive techniques aim to improve outcomes in complex congenital heart surgeries.

Purpose of the Study:

• To evaluate the postoperative outcomes of the extracardiac Fontan operation performed without cardiopulmonary bypass.
• To assess the feasibility and safety of this technique in patients with single ventricular physiology.
• To determine if avoiding cardiopulmonary bypass improves hemodynamic parameters and reduces complications.

Main Methods:

• Retrospective analysis of 10 consecutive patients undergoing extracardiac Fontan operation without cardiopulmonary bypass (March 1999 - August 2002).
• Exclusion of patients requiring intracardiac intervention; review of prior surgical history.
• Continuous monitoring of central venous pressure, blood pressure, and arterial oxygen saturation during the procedure.

Main Results:

• No intraoperative or postoperative deaths occurred.
• Mean arterial oxygen saturation significantly improved post-procedure (74.5% to 93.5%).
• Short intensive care unit (3.3 days) and hospital stays (15.4 days) were observed, with minimal need for inotropic support or blood transfusion.

Conclusions:

• Extracardiac Fontan operation without cardiopulmonary bypass is a safe and effective procedure.
• This technique demonstrates favorable short- and midterm outcomes with improved postoperative hemodynamics.
• Avoiding cardiopulmonary bypass in Fontan procedures may preserve organ function and reduce morbidity.