| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2001;122:1219-1228
© 2001 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease (CHD) |
From the Departments of Surgery and Pediatrics, Divisions of Cardiovascular Surgerya and Cardiology,b the Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada.
Received for publication Sept 14, 2000. Revisions requested Feb 27, 2001; revisions received April 24, 2001. Accepted for publication April 27, 2001. Address for reprints: William G. Williams, MD, Division of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Rm 1525, Toronto, Ontario M5G 1X8, Canada.
Abstract
Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period.
Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex, and weight did not differ between the 2 groups. Compared with the lateral tunnel group (LT group), patients undergoing the extracardiac conduit procedure (EC group) had a trend to a higher incidence of morphologically right ventricle (EC group 48% vs LT group 32%; P < .09), a higher incidence of isomerism/heterotaxy syndrome (EC 22% vs LT 0%; P < .001), worse atrioventricular valve regurgitation (EC 11% moderate-plus vs LT 0%; P < .06), and lower McGoon indices (EC 1.8 ± 0.5 vs LT 2.1 ± 0.5; P < .03). Preoperative arrhythmias, transpulmonary gradients, room air oxygen saturations, ejection fractions, ventricular end-diastolic pressure, and pulmonary artery distortion did not differ between groups. Cardiopulmonary bypass times and fenestration usage were similar in both groups.
Results: Overall operative mortality was 5.6% and did not differ between groups. The LT group had a significantly higher incidence of postoperative sinoatrial node dysfunction (45% vs EC group 15%; P < .007), supraventricular tachycardia (33% vs EC group 8%; P < .0009), and need for temporary postoperative pacing (32% vs 12%; P < .01). Median duration of intensive care unit stay (EC 2 days, range 1-10 days, vs LT 2.8 days, range 1-103 days; P < .07) and ventilatory support (EC 1 day, range 0.25-10 days, vs LT 1 day, range 0.25-99 days; P < .03) were all longer in the LT group. Median chest tube drainage (EC 8 days, LT 9 days) was similar in both groups. Follow-up averaged 2.5 ± 1.4 years in the EC group and 2.8 ± 1.9 years in the LT group. There were 2 late deaths. Overall survival is 94% at 1 month, 92% at 1 year, and 92% at 5 years. Late ejection fraction or atrioventricular valve function did not differ between groups. Intermediate follow-up Holter analysis showed a higher incidence of atrial arrhythmias in the LT group (23% vs 7%; P < .02). Multivariable analysis showed that (1) prolonged cardiopulmonary bypass time was the only independent predictor for perioperative mortality, prolonged ventilation and intensive care unit length of stay, and increased time to final removal of chest tube drains and (2) lateral tunnel Fontan connection is an independent predictor of early postoperative and intermediate atrial arrhythmias.
Conclusions: Although patients in the EC group were at higher preoperative risk, their outcomes were comparable with those of the LT group. Use of the extracardiac conduit technique for the modified Fontan operation reduces the risk of early and midterm atrial arrhythmia.
This article has been cited by other articles:
|
|
 |
|
  S.-J. Kim, W.-H. Kim, H.-G. Lim, and J.-Y. Lee Outcome of 200 patients after an extracardiac Fontan procedure J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 108 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ikai, Y. Fujimoto, K. Hirose, N. Ota, Y. Tosaka, T. Nakata, Y. Ide, and K. Sakamoto Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1145 - 1152. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Agematsu, Y. Naito, M. Aoki, and T. Fujiwara Total cavo-pulmonary connection without foreign material for asplenic heart associated with partial anomalous pulmonary venous connection Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 344 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Nakano, H. Kado, T. Tachibana, K. Hinokiyama, A. Shiose, M. Kajimoto, and Y. Ando Excellent Midterm Outcome of Extracardiac Conduit Total Cavopulmonary Connection: Results of 126 Cases Ann. Thorac. Surg., November 1, 2007; 84(5): 1619 - 1626. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Sharma, M. Kostolny, M. R. de Leval, and V. T. Tsang Surgical approaches for single ventricle palliation MMCTS, October 18, 2007; 2007(1018): 2394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S.D. Almond, J. E. Mayer Jr, R. R. Thiagarajan, E. D. Blume, P. J. del Nido, and D. B. McElhinney Outcome After Fontan Failure and Takedown to an Intermediate Palliative Circulation Ann. Thorac. Surg., September 1, 2007; 84(3): 880 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Lee, C.-H. Lee, S. W. Hwang, H. G. Lim, S.-J. Kim, J. Y. Lee, W.-S. Shim, and W.-H. Kim Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 1008 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Lee, J. Kwak, K. C. Kim, S. K. Min, W.-H. Kim, Y. J. Kim, and J. R. Rho Comparison of lateral tunnel and extracardiac conduit Fontan procedure Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 328 - 330. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Kanter The Fontan Right Atrium--In Context Circulation, April 3, 2007; 115(13): 1698 - 1700. [Full Text] [PDF]
|
|
|
|
|
|
R. B.M. Hosein, A. J.B. Clarke, S. P. McGuirk, M. Griselli, O. Stumper, J. V. De Giovanni, D. J. Barron, and W. J. Brawn Factors influencing early and late outcome following the Fontan procedure in the current era. The 'Two Commandments'? Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 344 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Fiore, M. Turrentine, M. Rodefeld, P. Vijay, T. L. Schwartz, K. S. Virgo, L. K. Fischer, and J. W. Brown Fontan Operation: A Comparison of Lateral Tunnel with Extracardiac Conduit Ann. Thorac. Surg., February 1, 2007; 83(2): 622 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Meyer, G. Zamora, G. Wernovsky, R. F. Ittenbach, P. R. Gallagher, S. Tabbutt, P. J. Gruber, S. C. Nicolson, J. W. Gaynor, and T. L. Spray Outcomes of the Fontan Procedure Using Cardiopulmonary Bypass with Aortic Cross-Clamping Ann. Thorac. Surg., November 1, 2006; 82(5): 1611 - 1620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Petrossian, V. M. Reddy, K. K. Collins, C. B. Culbertson, M. J. MacDonald, J. J. Lamberti, O. Reinhartz, R. D. Mainwaring, P. D. Francis, S. P. Malhotra, et al. The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J. Thorac. Cardiovasc. Surg., November 1, 2006; 132(5): 1054 - 1063. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pizarro, T. Mroczek, S. S. Gidding, J. D. Murphy, and W. I. Norwood Fontan Completion in Infants Ann. Thorac. Surg., June 1, 2006; 81(6): 2243 - 2249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Giannico, F. Hammad, A. Amodeo, G. Michielon, F. Drago, A. Turchetta, R. Di Donato, and S. P. Sanders Clinical Outcome of 193 Extracardiac Fontan Patients: The First 15 Years J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2065 - 2073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Aeba, R. Yozu, M. Morita, and T. Matayoshi Total Cavopulmonary Connection: Open Anastomosis of an Extracardiac Conduit With Vacuum-Assisted Venous Drainage. Ann. Thorac. Surg., March 1, 2006; 81(3): 1146 - 1147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Mitchell, R. F. Ittenbach, J. W. Gaynor, G. Wernovsky, S. Nicolson, and T. L. Spray Intermediate outcomes after the Fontan procedure in the current era J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 172 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Alphonso, M. Baghai, P. Sundar, R. Tulloh, C. Austin, and D. Anderson Intermediate-term outcome following the fontan operation: a survival, functional and risk-factor analysis Eur. J. Cardiothorac. Surg., October 1, 2005; 28(4): 529 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L.S. Morales, D. J. Dibardino, B. E. Braud, A. L. Fenrich, J. S. Heinle, W. K. Vaughn, E. D. McKenzie, and C. D. Fraser Jr Salvaging the Failing Fontan: Lateral Tunnel Versus Extracardiac Conduit Ann. Thorac. Surg., October 1, 2005; 80(4): 1445 - 1452. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-P. Xu, X.-J. Luo, J.-M. Chu, S.-J. Li, and Y.-L. Liu Total Cavopulmonary Connection with Off-Pump Technique Asian Cardiovasc Thorac Ann, September 1, 2005; 13(3): 225 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. K. Chowdhury, B. Airan, S. S. Kothari, S. Talwar, A. Saxena, R. Singh, G. K. Subramaniam, K. K. Pradeep, C. D. Patel, and P. Venugopal Specific Issues After Extracardiac Fontan Operation: Ventricular Function, Growth Potential, Arrhythmia, and Thromboembolism Ann. Thorac. Surg., August 1, 2005; 80(2): 665 - 672. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Kaulitz and M Hofbeck Current treatment and prognosis in children with functionally univentricular hearts Arch. Dis. Child., July 1, 2005; 90(7): 757 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Nurnberg, S. Ovroutski, V. Alexi-Meskishvili, P. Ewert, R. Hetzer, and Peter. E. Lange New Onset Arrhythmias After the Extracardiac Conduit Fontan Operation Compared With the Intraatrial Lateral Tunnel Procedure: Early and Midterm Results Ann. Thorac. Surg., December 1, 2004; 78(6): 1979 - 1988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Gupta, C. Daggett, S. Behera, M. Ferraro, W. Wells, and V. Starnes Risk factors for persistent pleural effusions after the extracardiac Fontan procedure J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1664 - 1669. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. K. Collins, E. K. Rhee, J. M. Delucca, M. E. Alexander, L. M. Bevilacqua, C. I. Berul, E. P. Walsh, J. E. Mayer, R. A. Jonas, P. J. del Nido, et al. Modification to the Fontan procedure for the prophylaxis of intra-atrial reentrant tachycardia: short-term results of a prospective randomized blinded trial J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 721 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Nakano, H. Kado, S. Ishikawa, Y. Shiokawa, H. Ushinohama, K. Sagawa, N. Fusazaki, Y. Nishimura, Y. Tanoue, T. Nakamura, et al. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 730 - 737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y.-T. Lan, R.-K. Chang, and H. Laks Outcome of patients with double-inlet left ventricle or tricuspid atresia with transposed great arteries J. Am. Coll. Cardiol., January 7, 2004; 43(1): 113 - 119. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Isomatsu, T. Shin'oka, G. Matsumura, N. Hibino, T. Konuma, M. Nagatsu, and H. Kurosawa Extracardiac total cavopulmonary connection using a tissue-engineered graft J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1958 - 1962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Kumar, C. S. Rubinstein, J. M. Simsic, A. B. Taylor, J. P. Saul, and S. M. Bradley Lateral tunnel versus extracardiac conduit fontan procedure: a concurrent comparison Ann. Thorac. Surg., November 1, 2003; 76(5): 1389 - 1397. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wells, M. Malas, C. J. Baker, S. M. Quardt, and M. L. Barr Depopulated vena caval homograft: a new venous conduit J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 498 - 503. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Baslaim, A. Hussain, A. Kouatli, and A. Jamjoom Bovine valved xenograft conduits in the extracardiac Fontan procedure J. Thorac. Cardiovasc. Surg., August 1, 2003; 126(2): 586 - 588. [Full Text] [PDF]
|
|
|
|
|
|
A. T. Yetman, J. Drummond-Webb, W. P. Fiser, M. L. Schmitz, M. Imamura, S. Ullah, R. J. Gunselman, C. W. Chipman, C. E. Johnson, and S. H. Van Devanter The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results Ann. Thorac. Surg., October 1, 2002; 74(4): S1416 - 1421. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
