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The modified Fontan procedure and prolonged pleural effusions

Christopher E Mascio1, Matthew Wayment, Tarah T Colaizy

  • 1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA. cmascio@ucsamd.com

The American Surgeon
|March 14, 2009
PubMed

Insights

Prolonged pleural effusions are common after the modified Fontan procedure. Higher preoperative pulmonary artery pressure may predict these effusions, impacting chest tube use and hospital stay.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Thoracic Surgery

Background:

  • The modified Fontan procedure is a critical surgery for single-ventricle congenital heart defects.
  • Prolonged pleural drainage is a frequent complication, but its predictors remain unclear.

Purpose of the Study:

  • To identify perioperative variables associated with prolonged pleural effusions following the modified Fontan procedure.
  • To understand risk factors for extended drainage and hospitalization after Fontan surgery.

Main Methods:

  • Retrospective analysis of 41 patients undergoing the modified Fontan procedure.
  • Comparison of perioperative data between patients with and without prolonged pleural effusions (defined as >14 days).
  • Statistical analysis to identify significant risk factors, including preoperative pulmonary artery pressure, Fontan type, and fenestration.

Main Results:

  • Ten patients (24%) experienced prolonged pleural effusions.
  • Patients with prolonged effusions had significantly higher mean chest tube output, longer chest tube duration, and increased length of hospital stay.
  • Elevated preoperative mean pulmonary artery pressure was significantly associated with prolonged effusions (P=0.001).
  • Fontan type, fenestration, and conduit size were not identified as risk factors.

Conclusions:

  • Prolonged pleural effusions are a significant complication after the modified Fontan procedure.
  • Preoperative mean pulmonary artery pressure is a potential predictor of prolonged pleural effusions.
  • Further research may focus on managing elevated pulmonary artery pressure to reduce effusions.

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