Fontan procedure with extracardiac conduit in pediatrics and children: Short-term results

Abstract

IntroductionThe concept of Fontan circulation was first clinically introduced in 1971. Technical modifications have been advocated with the concept of total cavopulmonary connection, introduced in the late 80s. Recently, an extracardiac conduit to divert inferior vena cava flow to the pulmonary arteries has been advocated, and it affords excellent palliation for patients with various forms of the anatomic or functional single ventricle.Patients and methodsFrom September 2019 to August 2021, 12 patients (five males and seven females) with a mean age of 10.7 (6–15) years underwent a Fontan procedure with extracardiac conduit at the National Heart Institute. The mean weight was 34.75 (18–60) kg. The underlying diagnoses included tricuspid atresia (n = 2), double-inlet left ventricle (n = 3), transposition of great arteries (n = 1), and double-outlet right ventricle (n = 6). All patients were in sinus rhythm.ResultsThere was one operative mortality. The type of conduit used was Gortex in 11 patients (91.7%) and Dacron in one patient (8.3%). The mean conduit size was 20 mm (16–26 mm). The mean cardiopulmonary bypass time was 127 (90–200) min. Aortic cross-clamping time was 25 min in two patients who needed total circulatory arrest. The mean duration of chest tube drainage was 31.8 days (15–130 days). All patients had sinus rhythm before the operation remained sinus. The mean ejection fraction was 65% (55–71%). The arterial oxygen saturation increased from a preoperative mean level of 64.2% (55–70%) to 90% (85–93%). There were nine patients (75%) who had fenestrations. The mean postoperative hospital stay was 36.7 (15–150) days, ICU stay was 6.5 (3–8) days, and mechanical ventilation time was 13.7 (4–27) h. There were three patients (25%) who needed reoperation, one who needed reintervention with chylous pleural effusion (8.3%), protein-losing enteropathy (8.3%), and infection. All patients had New York Heart Association (NYHA) functional class ≤II.ConclusionThe extracardiac conduit is an easy way to perform the Fontan procedure, as it provides an excellent early result, maintenance of sinus rhythm, and preservation of ventricular function.