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Doff B. McElhinney
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J Thorac Cardiovasc Surg 1999;117:688-696
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

EARLY RESULTS OF THE EXTRACARDIAC CONDUIT FONTAN OPERATION

Ed Petrossian, MD, V. Mohan Reddy, MD, Doff B. McElhinney, MD, George P. Akkersdijk, MD, Phillip Moore, MD, Andrew J. Parry, MD, LeNardo D. Thompson, MD, Frank L. Hanley, MD

From the Division of Cardiothoracic Surgery, University of California, San Francisco, Calif.

Presented in part at The Second World Congress of Pediatric Cardiology and Cardiac Surgery, Honolulu, Hawaii, May 1997.

Received for publication Feb 17, 1998. Revisions requested April 29, 1998. Revisions received Dec 14, 1998. Accepted for publication Dec 21, 1998. Address for reprints: Ed Petrossian, MD, UCSF Pediatric Cardiac Surgery, Valley Children's Hospital, 9300 Valley Children's Place, Madera, CA 93638.

Background: Among the modifications of the Fontan operation, the extracardiac approach may offer the greatest potential for optimizing early postoperative ventricular and pulmonary vascular function, insofar as it can be performed with short periods of normothermic partial cardiopulmonary bypass and without cardioplegic arrest in most cases. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus on early postoperative outcomes.
Methods and results: Between July 1992 and April 1997, 51 patients (median age 4.9 years) underwent an extracardiac conduit Fontan operation. Median cardiopulmonary bypass time was 92 minutes and has decreased significantly over the course of our experience. Intracardiac procedures were performed in only 5 patients (10%), and the aorta was crossclamped in only 11 (22%). Intraoperative fenestration was performed in 24 patients (47%). There were no early deaths. Fontan failure occurred in 1 patient who was a poor candidate for the Fontan procedure. Transient supraventricular tachyarrhythmias occurred in 5 patients (10%). Median duration of chest tube drainage was 8 days. Factors significantly associated with prolonged resource use (mechanical ventilation, inotropic support, intensive care unit stay, and hospital stay) included longer bypass time and higher Fontan pressure. At a median follow-up of 1.9 years, there was 1 death from bleeding at reoperation.
Conclusions: The extracardiac conduit Fontan procedure can be performed with minimal mortality and morbidity. Improved results may be related to advantages of the extracardiac approach and improved preservation of ventricular and pulmonary vascular function.




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