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J Thorac Cardiovasc Surg 2008;135:1145-1152
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms

^a Department of Cardiovascular Surgery, Iwate Medical University Memorial Heart Center, Shizuoka, Japan
^b Department of Cardiovascular Surgery, Shizuoka Children's Hospital, Shizuoka, Japan

Received for publication June 24, 2007; revisions received December 11, 2007; accepted for publication December 18, 2007.

^_* Address for reprints: Kisaburo Sakamoto, MD, Department of Cardiovascular Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka 420-8505, Japan. (Email: sakamoto{at}jun.ncvc.go.jp).

Objective: The extracardiac conduit Fontan procedure has led to improved outcomes. We performed the procedure in patients weighing less than 10 kg and evaluated its feasibility.

Methods: Since January 1999, 72 patients weighing less than 20 kg underwent extracardiac conduit Fontan procedure with polytetrafluoroethylene conduits. The patients were divided into 2 groups: 36 patients weighing less than 10 kg in group S and 36 weighing more than 10 kg in group L. Mean weight, median age, and median follow-up period in groups S and L were 8.5 ± 1.1 and 14.0 ± 3.0 kg, 18.9 and 42.0 months, and 29.2 (1.7–79.7) and 42.1 (2.8–94.2) months, respectively. Postoperatively, most patients received peritoneal drainage catheters. We reviewed data precatheterization and postcatheterization and postoperative course.

Results: Conduit sizes in groups S and L were 17.0 ± 1.3 and 17.9 ± 1.9 mm, respectively (P = .03). Five patients required fenestrations. There were 2 hospital deaths, 1 in each group, and 2 late deaths in group S. The postoperative course was identical in both groups, except for median length of stay in the intensive care unit and peritoneal drainage volume. Group S versus L: ventilator support, 11 versus 7 hours; pleural drainage, 9 days each; pleural drainage greater than 14 days, 6 versus 5 cases; peritoneal drainage, 8 versus 7 days; intensive care unit stay, 7 versus 4 days (P = .01), peritoneal drainage volume, 26.1 versus 14.1 mL · kg · d^–1 (P = .0007).

Conclusions: The early outcome of the extracardiac conduit Fontan procedure was satisfactory in patients weighing less than 10 kg. However, the required size of the conduit remains debatable.