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Extracardiac Fontan with direct cavopulmonary connections: midterm results
Huiwen Chen1, Haifa Hong, Zhongqun Zhu
1Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Direct cavopulmonary connections (DCPC) offer favorable midterm results for creating Fontan circulation in patients with univentricular hearts. This surgical approach demonstrates a low risk of complications and reinterventions, supporting its efficacy.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- Functionally univentricular hearts present complex challenges for achieving effective systemic circulation.
- The Fontan procedure is a palliative treatment, and its modifications aim to improve outcomes.
- Direct cavopulmonary connections (DCPC) are an alternative surgical strategy.
Purpose of the Study:
- To analyze the midterm outcomes of superior and inferior direct cavopulmonary connections (DCPC).
- To evaluate the safety and efficacy of DCPC in creating Fontan circulation for patients with univentricular hearts.
- To assess complication rates and the need for reinterventions.
Main Methods:
- Retrospective review of 30 consecutive patients undergoing DCPC between January 2005 and December 2011.
- Analysis of operative details including aortic cross-clamping, cardiopulmonary bypass (CPB) times, and fenestration.
- Assessment of postoperative complications, mortality, and long-term follow-up data.
Main Results:
- Zero operative and late mortality observed.
- Major complications included supraventricular tachycardia (1 patient), oliguria requiring dialysis (1 patient), and prolonged chest drainage (5 patients).
- Computational fluid dynamics suggested potential power efficiency benefits of DCPC.
Conclusions:
- Superior and inferior DCPCs are associated with low risk and reintervention rates in selected patients.
- The midterm results of DCPC for Fontan circulation are favorable.
- DCPC represents a viable surgical option for functionally univentricular hearts.
Objectives:
The aim of this study was to analyse the midterm results following superior and inferior direct cavopulmonary connections (DCPC) to create a Fontan circulation in patients with functionally univentricular hearts.
Methods:
A retrospective review of patients operated on between January 2005 and December 2011 was carried out.
Results:
Thirty consecutive patients who underwent this type of operation were retrospectively reviewed. There were 18 (60%) males and 12 (40%) females, with a median age of 69 months (range 16-150 months) and median weight of 23 kg (range 11-46 kg). Aortic cross-clamping was used in 10 patients, with a median cross-clamp time of 40 min (range 23-99) and a median cardiopulmonary bypass (CPB) time of 135 min (range 76-179 min). The remaining 20 patients were operated on without aortic cross-clamping. Their median CPB time was 104 min (range 78-139 min). Fenestration was performed in 16 patients. The associated intracardiac procedures were performed in 10 patients. The follow-up period ranged from 2 months to 6 years. Operative mortality and late mortality after discharge was zero. The major postoperative complications included supraventricular tachycardia in one patient, oliguria and peritoneal dialysis in one and chest drainage (>30 ml/day) persisting >7 days in five (20%). One patient developed sinus bradycardia in association with sinus pauses 2 months after discharge. One patient developed pericardial effusion 1 month after discharge. A computational fluid dynamic study was performed in one patient. The computational fluid dynamic study showed that DCPC may have a better power efficiency.
Conclusions:
Superior and inferior DCPCs to create a Fontan circulation in appropriately selected patients with functionally univentricular hearts can be performed with a low risk and a low rate of reinterventions. The midterm results are favourable.
