The impact of extracardiac conduit fontan without fenestration on early postoerative course

Abstract

The extracardiac conduit Fontan (ECF) operation is designed to improve postoperative outcome. Between 8/1998 and 8/2007 77 patients underwent an ECF. Eight patients underwent a Fontan to TCPC conversion. Median age at the time of ECF was 6 years (range 2 to 38). Preoperative median pulmonary artery pressure was 13mm Hg (range 4 to 18) and pulmonary vascular resistance was 2,8 (range 0,4 to 4,7). None of patients underwent a fenestration. Twenty two patients (28%) underwent a concomitant intracardiac procedure out of them 19 (24,6%) required cardioplegic arrest. Median cardiopulmonary bypass time was 111 minutes (range 60 to 236). On postoperative day one (POD1) the Fontan pressure was 14,2±3mm Hg (mean+-SD) and the transpulmonary gradient was 8,5±2,4. The POD1 Fontan pressure was found to be significantly higher in patients who had an intracardiac procedure performed. Median chest tube drainage was 14,5 days (range 5 to 210). Median ICU stay was 5 days (range 3 to 47) and hospital stay was 16 days (range 7 to 69). There was one early deaths (1,2%). Of 65 patients reviewed, only 5 patients (7,6%) had new persistent early postoperative arrhythmia or conduction block. Fontan failure occurred in one patient requiring take down of the ECF.