Mid-term follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure☆

Abstract

Extracardiac conduit Fontan procedure (ECFP) using Gore-Tex graft has been performed with increasing frequency for the patients with functional single ventricle. However, lack of growth potential and longevity of the conduit are consistent concerns and main points of criticism of the ECFP. In this study, we investigated the mid-term status of the Gore-Tex graft used in the ECFP by comparing the internal diameter of the graft with the inferior vena cava (IVC) diameter at 1 month and 5.2 years after the ECFP. Of 79 patients who underwent ECFP using Gore-Tex graft between November 1997 and December 2007, 33 patients who had completed cardiac catheterization at 1 month (21-73 days) and 5.2 years (3.3-9.6 years) after the ECFP were included in this study. We measured the internal diameter of the Gore-Tex graft and IVC at both catheterizations retrospectively. The size of the Gore-Tex graft used in the ECFP was 16 mm in 17 patients, 18 mm in 9 patients, and 20mm in 7 patients. Laminar flow through the conduits was maintained without any stenosis or kinking of the graft in these 33 patients. No intervention or reoperation related to the extracardiac conduit has been required. There were no significant differences in mean cross-sectional area (CSA) of the conduits at 1 month versus 5.2 years after the ECFP for each conduit size, and no significant changes in the conduit-to-IVC CSA ratio (0.98+/-0.40 vs 0.82+/-0.21 for 16 mm, 1.09+/-0.30 vs 0.92+/-0.33 for 18 mm, and 1.16+/-0.55 vs 0.94+/-0.44 for 20mm conduit). The conduit CSA and conduit-to-IVC CSA ratio remained unchanged in small caliber grafts down to 16 mm at 5.2 years after the ECFP. However, further investigation is necessary to evaluate the fate of the Gore-Tex graft and late hemodynamics in the patients with small conduits after they achieve full somatic growth.