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Outcomes of the extracardiac fontan procedure using cardıopulmonary bypass: early results
Murat Ugurlucan1, Eylem Yayla Tuncer2, Fusun Guzelmeric2
1Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
Insights
Extracardiac Fontan operations using cardiopulmonary bypass show no adverse effects on morbidity and mortality. This technique provides favorable short-term outcomes, including improved oxygen saturation and short hospital stays.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- The Fontan procedure is a palliative surgery for complex congenital heart disease.
- Extracardiac Fontan (ECF) operations offer potential advantages over intra-cardiac techniques.
- The use of cardiopulmonary bypass (CPB) during ECF has been debated.
Purpose of the Study:
- To assess the postoperative outcomes of the first 9 patients undergoing ECF using CPB.
- To evaluate the safety and efficacy of CPB in ECF procedures.
- To analyze short-term morbidity and mortality rates in ECF patients.
Main Methods:
- A cohort of 9 consecutive patients (age 4-17) underwent ECF with CPB.
- Operations were performed by a single surgeon with CPB at normothermia.
- Interposition of a tube graft between the inferior vena cava and right pulmonary artery was utilized.
Main Results:
- No mortality was observed; 7 of 9 patients were discharged without complications.
- Mean Fontan pressure was 12.3 mmHg and transpulmonary gradient was 6.9 mmHg.
- Mean arterial oxygen saturation improved significantly (76.1% to 93.5%), with short ICU and hospital stays.
Conclusions:
- ECF using CPB is associated with favorable short-term outcomes.
- The technique demonstrates satisfactory results regarding hemodynamics and morbidity.
- CPB can be safely employed in extracardiac Fontan operations.
Background:
Although the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.
Methods:
Between September 2011 and April 2013, 9 consecutive patients (3 males and 6 females) underwent extracardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon. The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the inferior vena cava and right pulmonary artery.
Results:
The mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged without complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventilation within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ± 1.9 days, respectively.
Conclusions:
The extracardiac Fontan operation performed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favorable postoperative hemodynamics and morbidity rates.
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