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Extra-cardiac and complex Fontan baffle fenestration using radio frequency current via surgical electrocautery
Asra Khan1, Athar M Qureshi1, Manish Bansal1
1Pediatric Interventional Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6651 Main Street, Suite E1920, Houston, TX 77030, USA.
Insights
Radiofrequency current via surgical electrocautery safely and effectively facilitates Fontan baffle puncture. This technique is crucial for diagnostic, electrophysiology, and interventional procedures in Fontan patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Fontan baffle puncture is challenging due to calcification and complex anatomy.
- Existing methods for Fontan fenestration can be difficult and carry risks.
Purpose of the Study:
- To evaluate the use of radiofrequency current via surgical electrocautery for Fontan baffle puncture.
- To assess its utility in facilitating various cardiac catheterization procedures.
Main Methods:
- Retrospective review of 19 Fontan patients undergoing baffle puncture with radiofrequency energy.
- Procedures performed across three centers from January 2011 to July 2021.
Main Results:
- 22 successful Fontan baffle punctures were achieved in 19 patients.
- Radiofrequency energy (10-50W) was effective in 1-5 attempts, with no complications.
- Successful punctures enabled diagnostic studies, electrophysiology procedures, and interventions for Fontan failure.
Conclusions:
- Radiofrequency current delivery using surgical electrocautery is a safe and effective method for Fontan baffle puncture.
- This technique facilitates procedures in complex and calcified Fontan baffles.
Background:
Fontan baffle punctures and creation of Fontan fenestration for cardiac catheterisation procedures remain challenging especially due to the heavy calcification of prosthetic material and complex anatomy.
Objectives:
We sought to evaluate our experience using radiofrequency current via surgical electrocautery needle for Fontan baffle puncture to facilitate diagnostic, electrophysiology, and interventional procedures.
Methods:
A retrospective chart review of all Fontan patients (pts) who underwent Fontan baffle puncture using radiofrequency energy via surgical electrocautery from three centres were performed from January 2011 to July 2021.
Results:
A total of 19 pts underwent 22 successful Fontan baffle puncture. The median age and weight were 17 (3-36 years) and 55 (14-88) kg, respectively. The procedural indications for Fontan fenestration creation included: diagnostic study (n = 1), atrial septostomy and stenting (n = 1), electrophysiology study and ablation procedures (n = 8), Fontan baffle stenting for Fontan failure including protein-losing enteropathy (n = 7), and occlusion of veno-venous collaterals (n = 2) for cyanosis. The type of Fontan baffles included: extra-cardiac conduits (n = 12), lateral tunnel (n = 5), classic atrio-pulmonary connection (n = 1), and intra-cardiac baffle (n = 1). A Fontan baffle puncture was initially attempted using traditional method in 6 pts and Baylis radiofrequency trans-septal system in 2 pts unsuccessfully. In all pts, Fontan baffle puncture using radiofrequency energy via electrocautery needle was successful. The radiofrequency energy utilised was (10-50 W) and required 1-5 attempts for 2-5 seconds. There were no vascular or neurological complications.
Conclusions:
Radiofrequency current delivery using surgical electrocautery facilitates Fontan baffle puncture in patients with complex and calcified Fontan baffles for diagnostic, interventional, and electrophysiology procedures.
