Outcomes of the Extracardiac Fontan Procedure Using Cardiopulmonary Bypass: Early Results

Authors

  • Murat Ugurlucan
  • Eylem Yayla Tuncer
  • Fusun Guzelmeric
  • Eylul Kafali
  • Omer Ali Sayin
  • Nihat Cine
  • Naci Oner
  • Ayse Yildirim
  • Hakan Ceyran
  • Murat Basaran

DOI:

https://doi.org/10.1532/HSF98.2014327

Abstract

Background: Although the avoidance of cardiopulmonary bypass during the Fontan procedure has potential advantages, using cardiopulmonary bypass during this procedure has no adverse effects in terms of morbidity and mortality rates. In this study, we assessed the postoperative outcomes of our first 9 patients who have undergone extracardiac Fontan operation by the same surgeon using cardiopulmonary bypass.

Methods: Between September 2011 and April 2013,  9 consecutive patients (3 males and 6 females) underwent extra-cardiac Fontan operation. All operations were performed under cardiopulmonary bypass at normothermia by the same surgeon.  The age of patients ranged between 4 and 17 (9.8 ± 4.2) years. Previous operations performed on these patients were modified Blalock-Taussig shunt procedure in 2 patients, bidirectional cavopulmonary shunt operation in 6 patients, and pulmonary arterial banding in 1 patient. Except 2 patients who required intracardiac intervention, cross-clamping was not applied. In all patients, the extracardiac Fontan procedure was carried out by interposing an appropriately sized tube graft between the infe-rior vena cava and right pulmonary artery.

Results: The mean intraoperative Fontan pressure and transpulmonary gradient were 12.3 ± 2.5 and 6.9 ± 2.2 mm Hg, respectively. Intraoperative fenestration was not required. There was no mortality and 7 patients were discharged with-out complications. Complications included persistent pleural effusion in 1 patient and a transient neurological event in 1 patient. All patients were weaned off mechanical ventila-tion within 24 hours. The mean arterial oxygen saturation increased from 76.1% ± 5.3% to 93.5% ± 2.2%. All patients were in sinus rhythm postoperatively. Five patients required blood and blood-product transfusions. The mean intensive care unit and hospital stay periods were 2.9 ± 1.7 and 8.2 ±  1.9 days, respectively.

Conclusions: The extracardiac Fontan operation per-formed using cardiopulmonary bypass provides satisfactory results in short-term follow-up and is associated with favor-able postoperative hemodynamics and morbidity rates.

References

Alexi-Meskishvili V, Ovroutski S, Dahnert I, Lange PE, Hetzer R. 2001. Early experience with extracardiac Fontan operation. Ann Thorac Surg 71:71-6.nAlphonso N, Baghai M, Sundar P, Tulloh R, Austin C, Anderson D. 2005. Intermediate-term outcome following the Fontan operation: a survival, functional, and risk-factor analysis. Eur J Cardiothorac Surg 28:529-35.nAmodeo A, Galletti L, Marianeschi S, et al. 1997. Extracardiac Fontan operation for complex cardiac anomalies: seven years' experience. J Thorac Cardiovasc Surg 114:1020-30.nAzakie A, McCrindle BW, Van Arsdell GS, et al. 2001. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 122:1219-28.nd'Udekem Y, Iyengar AJ, Cochrane AD, et al. 2007. The Fontan procedure: contemporary techniques have improved longterm outcomes. Circulation 116(Suppl):I157-64.nFontan F, Baudet E. 1971. Surgical repair of tricuspid atresia. Thorax 26:240-8.nJahangiri M, Ross DB, Redington AN, Lincoln C, Shinebourne EA. 1994. Thromboembolism after the Fontan procedure and its modifications. Ann Thorac Surg 58:1409-14.nKim SJ, Kim WH, Lim HG, Lee JY. 2008. Outcome of 200 patients after an extracardiac Fontan procedure. J Thorac Cardiovasc Surg 136:108-16.nKawahira Y, Uemura H, Yagihara T. 2006. Impact of the off-pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg 81:685-9.nKogon BE, Plattner C, Leong T, Simsic J, Kirshbom PM, Kanter KR. 2008. The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 136:1237-42.nKumar SP, Rubinstein CS, Simsic JM, Taylor AB, Saul JP, Bradley SM. 2003. Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. Ann Thorac Surg 76:1389 -97.nLaPar DJ, Mery CM, Peeler BB, Kron IL, Gangemi JJ. 2012. Short and long-term outcomes for bidirectional Glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg 94:164-70; discussion 170-1.nLardo AC, Webber SA, Friehs I, del Nido PJ, Cape EG. 1999. Fluid dynamic comparison of intraatrial and extra cardiac total cavopulmonary connections. J Thorac Cardiovasc Surg 117:697-704.nMarcelletti CF, Hanley FL, Mavroudis C, et al. 2000. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: a multicenter experience. J Thorac Cardiovasc Surg 199:340-6.nMarcelletti CF, Iorio FS, Abella RF. 1999. Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2:131-42.nMcElhinney DB, Petrossian E, Reddy VM, Hanley FL. 1998. Extracardiac conduit Fontan procedure without cardiopulmonary bypass. Ann Thorac Surg 66:1826-8.nMeyer DB, Zamora G, Wernovsky G, et al. 2006. Outcomes of the Fontan procedure using cardiopulmonary bypass with aortic cross-clamping. Ann Thorac Surg 82:1611-8; discussion 1618-20.nNakano T, Kado H, Ishikawa S, et al. 2004. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac method. J Thorac Cardiovasc Surg 127:730-7.nOcello S, Salviato N, Marcelletti CF. 2007. Results of 100 consecutive extracardiac conduit Fontan operations. Pediatr Cardiol 28:433-7.nOhuchi H, Kagisaki K, Miyazaki A, et al. 2011. Impact of the evolution of the Fontan operation on early and late mortality: a single-center experience of 405 patients over 3 decades. Ann Thorac Surg 92:1457-66.nPetrossian E, Reddy VM, Collins KK, et al. 2006. The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J Thorac Cardiovasc Surg 132:1054-63.nPetrossian E, Thompson LD, Hanley FL. 2000. Extracardiac conduit variation of the Fontan procedure. Adv Card Surg 12:175-98.nTam VK, Miller BE, Murphy K. 1999. Modified Fontan without use of cardiopulmonary bypass. Ann Thorac Surg 68:1698-703; discussion 1703-4.nTireli E, Ugurlucan M, Basaran M, et al. 2006. Extracardiac Fontan operation without cardiopulmonary bypass. J Cardiovasc Surg 47:699-704.nVan Doorn CA, De Leval MR. 2005. The Fontan operation in clinical practice: indications and controversies. Nat Clin Pract Cardiovasc Med 2:116-7.nvan Slooten YJ, Elzenga NJ, Waterbolk TW, van Melle JP, Berger RM, Ebels T. 2012. The effect of additional pulmonary blood flow on timing of the total avopulmonary connection. Ann Thorac Surg 93:2028-33.nYetman AT, Drummond-Webb J, Fiser WP, et al. 2002. The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results. Ann Thorac Surg 74:S1416-21.n

Published

2014-07-03

How to Cite

Ugurlucan, M., Tuncer, E. Y., Guzelmeric, F., Kafali, E., Sayin, O. A., Cine, N., Oner, N., Yildirim, A., Ceyran, H., & Basaran, M. (2014). Outcomes of the Extracardiac Fontan Procedure Using Cardiopulmonary Bypass: Early Results. The Heart Surgery Forum, 17(3), E173-E177. https://doi.org/10.1532/HSF98.2014327

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