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Is it necessary to routinely fenestrate an extracardiac fontan?
J Am Coll Cardiol. 1999 Aug; 34(2):539-44.JACC

Abstract

OBJECTIVES

This study was conducted to assess the need for, and use of, fenestration of an extracardiac conduit Fontan.

BACKGROUND

Fenestration of a Fontan connection has been proposed as a means of improving outcomes of single ventricle palliation. The benefit of fenestration is likely to be greatest in the early postoperative period when patients may experience increased pulmonary vascular resistance and decreased ventricular function due to the effects of cardiopulmonary bypass, aortic cross-clamping and positive pressure ventilation. However, there are potential drawbacks to fenestration. The utility of fenestration with extracardiac Fontan operation has not been determined.

METHODS

Since 1992, 81 patients have undergone a modification of the Fontan procedure in which an extracardiac inferior cavopulmonary conduit is used in combination with a previously staged bidirectional Glenn anastomosis. We conducted a retrospective review of these patients.

RESULTS

Fenestration was performed selectively in 32 patients (39%), including only 2 of the last 38 (5%). In seven patients, a fenestration was placed or clipped in the early postoperative period without cardiopulmonary bypass. There were two operative deaths. Prolonged (>2 weeks) pleural drainage occurred in 13 patients, 8 with fenestration and 5 without. In addition to undergoing earlier Fontan in our experience, patients who had a fenestration placed had significantly higher preoperative pulmonary vascular resistance, significantly higher common atrial pressure after Fontan and significantly lower post-Fontan systemic arterial oxygen saturation. Fontan pressure did not differ between nonfenestrated and fenestrated patients. At follow-up ranging to five years, there were two late deaths and no patients developed protein losing enteropathy.

CONCLUSIONS

Fenestration is not necessary in most Fontan patients when an extracardiac conduit technique is performed as described in this article, and therefore, should not be performed routinely with the extracardiac conduit Fontan. The need for fenestration should be assessed after cardiopulmonary bypass when hemodynamics can be evaluated accurately. Fenestration can be placed and revised easily without bypass and with minimal intervention in patients with an extracardiac conduit Fontan.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10440170

Citation

Thompson, L D., et al. "Is It Necessary to Routinely Fenestrate an Extracardiac Fontan?" Journal of the American College of Cardiology, vol. 34, no. 2, 1999, pp. 539-44.
Thompson LD, Petrossian E, McElhinney DB, et al. Is it necessary to routinely fenestrate an extracardiac fontan? J Am Coll Cardiol. 1999;34(2):539-44.
Thompson, L. D., Petrossian, E., McElhinney, D. B., Abrikosova, N. A., Moore, P., Reddy, V. M., & Hanley, F. L. (1999). Is it necessary to routinely fenestrate an extracardiac fontan? Journal of the American College of Cardiology, 34(2), 539-44.
Thompson LD, et al. Is It Necessary to Routinely Fenestrate an Extracardiac Fontan. J Am Coll Cardiol. 1999;34(2):539-44. PubMed PMID: 10440170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is it necessary to routinely fenestrate an extracardiac fontan? AU - Thompson,L D, AU - Petrossian,E, AU - McElhinney,D B, AU - Abrikosova,N A, AU - Moore,P, AU - Reddy,V M, AU - Hanley,F L, PY - 1999/8/10/pubmed PY - 1999/8/10/medline PY - 1999/8/10/entrez SP - 539 EP - 44 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 34 IS - 2 N2 - OBJECTIVES: This study was conducted to assess the need for, and use of, fenestration of an extracardiac conduit Fontan. BACKGROUND: Fenestration of a Fontan connection has been proposed as a means of improving outcomes of single ventricle palliation. The benefit of fenestration is likely to be greatest in the early postoperative period when patients may experience increased pulmonary vascular resistance and decreased ventricular function due to the effects of cardiopulmonary bypass, aortic cross-clamping and positive pressure ventilation. However, there are potential drawbacks to fenestration. The utility of fenestration with extracardiac Fontan operation has not been determined. METHODS: Since 1992, 81 patients have undergone a modification of the Fontan procedure in which an extracardiac inferior cavopulmonary conduit is used in combination with a previously staged bidirectional Glenn anastomosis. We conducted a retrospective review of these patients. RESULTS: Fenestration was performed selectively in 32 patients (39%), including only 2 of the last 38 (5%). In seven patients, a fenestration was placed or clipped in the early postoperative period without cardiopulmonary bypass. There were two operative deaths. Prolonged (>2 weeks) pleural drainage occurred in 13 patients, 8 with fenestration and 5 without. In addition to undergoing earlier Fontan in our experience, patients who had a fenestration placed had significantly higher preoperative pulmonary vascular resistance, significantly higher common atrial pressure after Fontan and significantly lower post-Fontan systemic arterial oxygen saturation. Fontan pressure did not differ between nonfenestrated and fenestrated patients. At follow-up ranging to five years, there were two late deaths and no patients developed protein losing enteropathy. CONCLUSIONS: Fenestration is not necessary in most Fontan patients when an extracardiac conduit technique is performed as described in this article, and therefore, should not be performed routinely with the extracardiac conduit Fontan. The need for fenestration should be assessed after cardiopulmonary bypass when hemodynamics can be evaluated accurately. Fenestration can be placed and revised easily without bypass and with minimal intervention in patients with an extracardiac conduit Fontan. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/10440170/Is_it_necessary_to_routinely_fenestrate_an_extracardiac_fontan L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(99)00228-4 DB - PRIME DP - Unbound Medicine ER -