Use of a fenestration should be routine during the Fontan procedure: PRO

The physiologic effects of a fenestration are to decrease "Fontan pressure" and systemic oxygen saturation, but to improve both cardiac index and systemic oxygen delivery. Several nonrandomized studies have shown that a fenestration improves clinical outcomes by decreasing the duration of postoperative effusions and the length of hospital stay. The single prospective, randomized study has also shown that use of a fenestration improves clinical outcomes. While there are some disadvantages to a fenestration; these are of relatively limited clinical importance. Selective rather than routine use of a fenestration relies on the ability to predict outcome based on preoperative or intraoperative variables. However, none of these variables has been found to have useful predictive value in the individual patient. In conclusion, the Fontan procedure can be done without a fenestration, with good outcomes. However, the positive effects of a fenestration on duration of effusions and length of hospital stay argue that use of a fenestration should be routine during the Fontan procedure.