Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Vascular Physiology

Background:

• Single ventricle physiology presents complex surgical challenges.
• The Fontan procedure is a palliative surgery for single ventricle defects.
• Fenestration in the Fontan circuit is a debated topic.

Purpose of the Study:

• To evaluate the efficacy and safety of a two-staged extracardiac Fontan procedure without fenestration.
• To assess the role of pulmonary vasodilation therapy in this surgical approach.
• To analyze long-term outcomes in patients undergoing this modified Fontan procedure.

Main Methods:

• Seventy-two patients with single ventricle physiology underwent a modified Fontan procedure using an extracardiac conduit without fenestration.
• Postoperative management included nitric oxide inhalation, phosphodiesterase III inhibitors, and oral pulmonary vascular dilators.
• Home oxygen therapy was administered for three months post-discharge.

Main Results:

• No hospital mortality was observed.
• The mean follow-up period was 44.2 months, with one late death after re-operation.
• Post-Fontan cardiac catheterization showed a transpulmonary gradient of 5.9 mmHg and systemic output of 3.4 l/min/m².
• The average arterial oxygen saturation (SaO(2)) at the latest outpatient visit was 94.4%.

Conclusions:

• Fenestration is not essential in a two-staged extracardiac Fontan completion.
• Pulmonary vasodilation therapy is crucial for successful outcomes with this technique.
• The two-staged extracardiac total cavopulmonary connection without fenestration is a viable and effective surgical option.