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Early outcomes after extracardiac conduit Fontan operation without cardiopulmonary bypass
Amy N McCammond1, Kevin Kuo, Victoria N Parikh
1Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, 707 SW Gaines Road, CDRC-P, Portland, OR 97239, USA. mccammoa@ohsu.edu
Insights
Avoiding cardiopulmonary bypass during the Fontan procedure for congenital heart defects did not significantly improve early postoperative outcomes. While it influenced intraoperative hemodynamics and fenestration rates, it did not impact recovery metrics in children.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Surgical Palliation
Background:
- Cardiopulmonary bypass (CPB) is linked to systemic inflammatory responses.
- The Fontan operation is the final surgical palliation for univentricular congenital heart defects.
- Hypothesis: Avoiding CPB may improve outcomes in extracardiac Fontan procedures.
Purpose of the Study:
- To evaluate the impact of avoiding cardiopulmonary bypass on early postoperative outcomes in extracardiac Fontan operations.
- To compare intraoperative and postoperative parameters between patients who underwent CPB and those who did not.
Main Methods:
- Retrospective review of 73 patients undergoing initial Fontan operations (Nov 2001-Nov 2006).
- Patients divided into two groups: CPB (n=26) and off-CPB (n=47).
- Analysis of preoperative demographics, hemodynamics, and early postoperative outcomes.
Main Results:
- Off-CPB group had comparable demographics but greater average weight.
- Off-CPB group showed a trend towards lower Fontan fenestration rates (4.3% vs 19.2%).
- Off-CPB group had significantly lower intraoperative pressures and blood product requirements (P ≤ 0.01).
- No significant differences in early postoperative outcomes including ICU/hospital stay or ventilation duration were observed.
Conclusions:
- Avoiding cardiopulmonary bypass in extracardiac Fontan operations influences intraoperative hemodynamics and fenestration rates.
- The study did not find a significant impact on early postoperative outcomes for children undergoing the Fontan procedure without CPB.
Abstract:
Cardiopulmonary bypass is associated with a systemic inflammatory response. The authors hypothesized that avoiding cardiopulmonary bypass would lead to improved postoperative outcomes for patients undergoing the extracardiac Fontan operation, the final stage in surgical palliation of univentricular congenital heart defects. A review of the Children's Heart Center Database showed a total of 73 patients who underwent an initial Fontan operation at Lucile Packard Children's Hospital at Stanford between 1 November 2001 and 1 November 2006. These patients were divided into two groups: those who underwent cardiopulmonary bypass (n = 26) and those who avoided cardiopulmonary bypass (n = 47). Preoperative demographics, hemodynamics, and early postoperative outcomes were analyzed. The two groups had comparable preoperative demographic characteristics and hemodynamics except that the average weight of the off-bypass group was greater (17.9 ± 9.1 vs 14.2 ± 2.7 kg; P = 0.01). Intraoperatively, the off-bypass group trended toward a lower rate of Fontan fenestration (4.3 vs 19.2%; P = 0.09), had lower common atrial pressures (4.6 ± 1.4 vs 5.5 ± 1.5 mmHg; P = 0.05), and Fontan pressures (11.9 ± 2.1 vs 14.2 ± 2.4 mmHg; P ≤ 0.01), and required less blood product (59.1 ± 37.6 vs 91.9 ± 49.4 ml/kg; P ≤ 0.01). Postoperatively, there were no significant differences in hemodynamic parameters, postoperative colloid requirements, duration of mechanical ventilation, volume or duration of pleural drainage, or duration of cardiovascular intensive care unit or hospital stay. Avoiding cardiopulmonary bypass influenced intraoperative hemodynamics and the incidence of fenestration but did not have a significant impact on the early postoperative outcomes of children undergoing the Fontan procedure.
