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J Thorac Cardiovasc Surg 2003;125:465-471
© 2003 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
From the Divisions of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, the University of Washington School of Medicine, Seattle, Wash,a the Cleveland Clinic, Cleveland, Ohio,b and Phoenix Children's Hospital, Phoenix, Ariz.c
Read at the Twenty-eighth Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.
Received for publication June 27, 2002. Revisions requested Aug 1, 2002; revisions received Aug 23, 2002. Accepted for publication Aug 28, 2002. Address for reprints: Flavian M. Lupinetti, MD, 1144 E. McDowell Rd, Suite 204, Phoenix, AZ 85006 (E-mail: fmlupinetti{at}hotmail.com).
Objective: This study was designed to determine whether either of 2 alternative methods of extracardiac Fontan reconstruction provides superior results.
Methods: We reviewed 58 consecutive Fontan procedures performed between 1995 and 2001 with a pedicled pericardial tunnel (group P, n = 21) or an extracardiac conduit of polytetrafluoroethylene or allograft aorta (group C, n = 37). Operations were performed with cardiopulmonary bypass at 32°C; an aortic crossclamp was applied in only 6 patients. All group P patients and 33 (89%) group C patients received fenestrations.
Results: The groups were similar in terms of age, weight, anatomy, and preoperative hemodynamics. There were 3 hospital deaths (5%; 70% confidence limit, 2%-30%), all in group C. Median durations of mechanical ventilation (group P, 1 day; group C, 1 day), intensive care unit stay (group P, 3 days; group C, 3 days), chest tube drainage (group P, 8 days; group C, 7 days), and hospitalization (group P, 10 days; group C, 9 days) were not significantly different. There were no late deaths. All patients received warfarin sodium, and there were no late strokes. Before the Fontan procedure, 1 patient in group P and 3 patients in group C required pacemaker implants. Of the 51 surviving patients in sinus rhythm before the Fontan procedure, only 1 patient in group C subsequently required a pacemaker.
Conclusions: Extracardiac Fontan procedures with either a pericardial baffle or conduit are associated with low operative mortality and low risks of arrhythmia and late thromboembolic complication.
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