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Fontan operation: a technique in evolution.

Fernando Antonio Fantini¹, Bayard Gontijo, Cristiane Martins

¹Biocor Instituto, Brazil. fernandofantini@uaivip.com.br

Revista Brasileira De Cirurgia Cardiovascular : Orgao Oficial Da Sociedade Brasileira De Cirurgia Cardiovascular

|March 23, 2010

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Total cavopulmonary anastomosis (TCPA) offers surgical solutions for congenital heart defects. Intracardiac TCPA demonstrates reduced postoperative complications and shorter hospital stays, making it the preferred method.

Area of Science:

Cardiovascular Surgery
Pediatric Cardiology
Congenital Heart Disease

Background:

Total cavopulmonary anastomosis (TCPA) is a surgical approach for complex congenital heart defects.
Optimal surgical techniques for TCPA remain under investigation.
Previous Glenn anastomosis is a prerequisite for TCPA.

Purpose of the Study:

To compare the immediate outcomes of three distinct TCPA surgical techniques.
To identify the most effective TCPA surgical arrangement.

Main Methods:

Retrospective analysis of 40 patients undergoing TCPA between January 2005 and July 2008.
Comparison of three techniques: lateral tunnel (G1), extracardiac conduits (G2), and intracardiac conduit to the left pulmonary artery (G3).
All patients underwent fenestration.

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Main Results:

Surgical mortality was 9.1% in G1, 10% in G2, and 0% in G3 (not statistically significant).
Pleural effusion was significantly lower in G3 (0%) compared to G1 and G2 (P=0.0128).
Hospitalization time was significantly shorter in G3 (8 days) versus G1 (18 days) and G2 (13 days) (P=0.0164).

Conclusions:

Intracardiac TCPA (G3) is associated with significantly lower postoperative morbidity, including reduced pleural effusion and shorter hospital stays.
The intracardiac conduit technique is currently the preferred method for TCPA due to favorable outcomes.