Evolution of the Fontan-Kreutzer procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Physiology

Background:

• The Fontan-Kreutzer procedure is a palliative surgical treatment for complex single-ventricle congenital heart defects.
• Early surgical techniques focused on external power sources for pulmonary circulation, which proved suboptimal.
• Advancements in understanding hemodynamics are crucial for improving outcomes.

Purpose of the Study:

• To review the evolution of surgical techniques for Fontan-Kreutzer circulation.
• To highlight innovations that have improved patient outcomes.
• To discuss the persistent challenges and late morbidities associated with this procedure.

Main Methods:

• Review of historical surgical approaches for Fontan-Kreutzer circulation.
• Analysis of physiological principles guiding procedural modifications.
• Examination of clinical outcomes and long-term follow-up data.

Main Results:

• Surgical techniques have evolved from requiring external power sources to optimizing intra-circulatory flow dynamics.
• The total cavopulmonary connection (TCPC) was developed to minimize energy losses and flow disturbances.
• Innovations like staging and fenestration have expanded the applicability of the Fontan-Kreutzer procedure, notably for hypoplastic left heart syndrome (HLHS).

Conclusions:

• Significant improvements in early mortality and morbidity have been achieved with modern Fontan-Kreutzer circulation techniques.
• Despite advancements, ongoing late attrition and morbidity remain critical concerns for patients with Fontan-Kreutzer circulation.
• Continued research and monitoring are essential for managing long-term sequelae.