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Staged Fontan operation for complex cardiac anomalies with subaortic obstruction
R M Di Donato1, A Amodeo, D D di Carlo
1Department of Pediatric Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy.
The Journal of Thoracic and Cardiovascular Surgery
|March 1, 1993
Summary
This study introduces a novel two-stage palliation for complex heart defects, reducing ventricular load and improving oxygenation before Fontan operation. This approach demonstrated reduced mortality in patients awaiting definitive cardiac repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- Ventricular hypertrophy poses risks for Fontan operation in complex cardiac anomalies.
- Unrestricted pulmonary blood flow and subaortic obstruction complicate surgical management.
- Existing treatments necessitate innovative palliative strategies.
Purpose of the Study:
- To evaluate a new staged palliative approach for complex cardiac anomalies with ventricular hypertrophy.
- To assess the safety and efficacy of combining main pulmonary artery-ascending aorta anastomosis with bidirectional cavopulmonary anastomosis.
- To determine the impact of this palliation on subsequent Fontan operation outcomes.
Main Methods:
- A cohort of 23 patients with complex cardiac anomalies underwent a novel two-stage palliation between 1986 and 1991.
- The palliative procedure involved a main pulmonary artery-ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis.
- Patient data, including age, cardiac diagnosis, subaortic obstruction criteria, and outcomes, were retrospectively analyzed.
Main Results:
- Hospital mortality was 21.7% (5/23), with higher mortality in patients over 7 years old (not statistically significant).
- Survival rates at 1 and 5 years post-palliation were 78% and 63% respectively among hospital survivors.
- Post-palliation catheterization showed reduced subaortic gradients, acceptable cavopulmonary pressures, and improved arterial oxygen saturation (83%).
- Nine patients successfully underwent secondary Fontan repair without mortality; one died during attempted repair elsewhere (overall mortality at repair 10%).
Conclusions:
- This staged palliative approach effectively reduces ventricular pressure and volume load.
- The strategy provides adequate oxygenation, preparing patients for definitive Fontan repair.
- The staged palliation appears to reduce mortality associated with the definitive Fontan operation.