A new surgical technique for transcatheter Fontan completion

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomedical Engineering

Background:

• Complex congenital heart defects often necessitate palliative surgeries to separate pulmonary and systemic circulations.
• Current transcatheter techniques for Fontan completion are under development.
• A modified surgical preparation is needed to optimize transcatheter Fontan completion.

Purpose of the Study:

• To present a novel modified surgical technique for preparing patients for transcatheter Fontan completion.
• To improve the feasibility and outcomes of transcatheter Fontan completion procedures.

Main Methods:

• A surgical preparation technique was developed and tested in sixteen sheep.
• Key modifications included creating a superior vena cava (SVC) to pulmonary artery (PA) connection and using an occluding stent between the SVC and right atrium (RA).
• Nitinol rings were used for inferior vena cava (IVC) stent anchorage, followed by transcatheter stent placement to complete the Fontan-like circulation.

Main Results:

• The SVC to PA connection was successfully created in all animals.
• The occluding stent and nitinol rings facilitated precise stent placement and enhanced stability.
• Transcatheter completion was achieved, re-establishing the necessary circulatory pathway with minor complications.

Conclusions:

• The described surgical modifications improve preparation for transcatheter completion of partial cavopulmonary connection.
• The occluding stent aids in precise RA to PA connection and stent stability.
• Nitinol rings enhance the anchorage of covered stents for improved inferior connection.