Fontan modification for subsequent non-surgical Fontan completion.

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Establishment of Fontan circulation in complex univentricular hearts often requires several surgical procedures. We developed a procedure which maintains the advantages of a staged approach, however, during the initial surgery additional preparatory measures are performed to allow subsequent non-surgical Fontan completion. The operation is a lateral baffle Fontan procedure. The baffle bears multiple perforations to allow the inferior vena cava blood to drain into the systemic atrium. Total cavopulmonary connection is performed as usual and the cardiac end of the superior vena cava is subtotally banded. Formally the operation establishes a bi-directional Glenn physiology. During subsequent catheter intervention the banding of the superior vena cava is dilated and the holes in the baffle are closed with appropriate devices. From April 1994 to December 1995, 18 children having at least two risk factors for Fontan operation received the above described operation. Ages ranged from 3 months to 15 years. Ten patients had one or more previous operations. Bypass time ranged from 86 to 128 min and cross clamp time from 14 to 79 min. O2 saturation after discontinuation of cardiopulmonary bypass was 76% (70-81%). The postoperative recovery of all patients was rapid with early extubation (mean 6 h) and discharge to the ward the morning of the first postoperative day. One patient died. No fluid retention as pericardial, pleural or abdominal fluid effusions occurred. At discharge O2 saturation was 77% (75-82%). In thirteen children successful conversion to total cavopulmonary connection with interventional debanding of the superior vena cava and closure of the fenestrations was performed. After a hospital stay of only a couple of days the children were discharged with normal O2 saturation after Fontan completion. We suggest that this modification of the staged Fontan procedure reduces the need for surgical interventions by applying balloon angioplasty and occluder technology to this unique subset of patients.