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Outcomes after extracardiac Fontan procedure with a 16-mm polytetrafluoroethylene conduit
Sungkyu Cho1, Woong-Han Kim2, Eun Seok Choi1
1Department of Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea.
Objectives:
We evaluated the outcomes of patients who underwent extracardiac Fontan circulation procedures (ECFP) and received 16-mm polytetrafluoroethylene conduits.
Methods:
From June 1997 to May 2015, among the 408 patients who underwent ECFP, 66 patients (Group S) also received 16-mm polytetrafluoroethylene conduits. To compare this patient cohort with similarly sized patients who received larger conduits, a matched cohort (66 patients, Group L) was selected according to age and body weight.
Results:
The mean age, body weight and Nakata index at ECFP in Groups S and L were 2.9 ± 1.2 and 3.1 ± 1.2 years (P = 0.243), 13.0 ± 2.4 and 13.0 ± 2.3 kg (P = 0.101), 175.3 ± 59.0 and 236.1 ± 75.1 mm2/m2 (P = 0.005), respectively. The mean follow-up periods for Groups S and L were 7.8 ± 6.0 and 9.1 ± 4.9 years (P = 0.150), respectively. The conduit size of Group L was 19.2 ± 1.4 mm (P < 0.001). There was no significant difference in mortality between the groups (P = 0.109). The freedom from reoperation was 94.0 ± 3.4% in Group S and 79.3 ± 5.7% in Group L after 10 years (P = 0.070). Late-occurring morbidities included protein-losing enteropathy (2 in Group S, 4 in Group L; P = 0.491) and thromboembolism (0 in Group S, 4 in Group L; P = 0.206). There was a significant difference in conduit-related events between the groups (1 in Group S, 5 in Group L; P = 0.031). In a paired cohort from the 2 groups including patients who were followed-up for more than 10 years (15 patients from each group), the body mass index was 51.0 ± 33.2% in Group S and 30.3 ± 34.2% in Group L. The decreases in the conduit cross-sectional areas for the paired patients in Group S (n = 20) and Group L (n = 20) were 14.9 ± 19.7% and 24.5 ± 15.5% (P = 0.076), respectively. Coarse liver parenchyma was detected in 9 of 23 (39.1%) patients from Group S and in 7 of 18 (38.8%) patients from Group L upon ultrasonography.
Conclusions:
The 16-mm polytetrafluoroethylene conduit for ECFP showed acceptable outcomes and good haemodynamic status in small-sized patients. According to our results, small patients do not require large conduits to accommodate their growth potential.
