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Fontan completion without surgery.

Ahmad Sallehuddin1, Abdulrahman Mesned, Maie Barakati

  • 1King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. asallehuddin@kfshrc.edu.sa

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 1, 2007
PubMed
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This study presents a modified surgical approach for the Fontan procedure, enabling non-surgical transcatheter completion. This method improves oxygen saturation and avoids multiple surgeries for single ventricle patients.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Interventional Cardiology

Background:

  • The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
  • Modifications to the Fontan procedure aim to improve outcomes and facilitate completion.
  • Transcatheter interventions offer a less invasive approach for cardiovascular procedures.

Purpose of the Study:

  • To describe a novel modification for the Fontan procedure enabling non-surgical transcatheter completion.
  • To evaluate the short-term outcomes of this modified approach in pediatric patients.

Main Methods:

  • A surgical modification involving a fenestrated intra-atrial lateral tunnel and a patch on the superior vena cava (SVC) was performed.
  • Transcatheter completion involved RF perforation, balloon dilation, and stenting of the SVC patch, with device closure of the fenestration.

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  • Paired t-tests were used to compare pre- and post-completion physiological data.

    • Main Results:

    • 16 patients underwent the initial surgery; 9 later had transcatheter completion.
    • Oxygen saturation significantly increased from 85% to 94% (p=0.001).
    • No operative deaths, mechanical ventilation, effusions, or arrhythmias were observed; patients discharged within 6 days.

    Conclusions:

    • Non-surgical transcatheter Fontan completion is feasible and safe in selected patients.
    • This approach reduces mortality and morbidity compared to multiple surgical interventions.
    • It allows for staged palliation and accommodates growth through successive dilations.