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Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison.
Ann Thorac Surg. 2003 Nov; 76(5):1389-96; discussion 1396-7.AT

Abstract

BACKGROUND

The aim of this study was to compare the outcomes of the lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution over the same time period.

METHODS

From November 1995 through October 2002, 70 Fontan procedures were performed: 37 LT and 33 ECC. All were fenestrated; 96% were staged with a prior superior cavopulmonary connection. Compared with the ECC patients, the LT patients were younger (2.7 +/- 1.1 vs 3.9 +/- 2.5 years; p = 0.01), had a higher incidence of hypoplastic left heart syndrome (57% vs 21%; p < 0.01), and a longer aortic cross-clamp time (55 +/- 13 vs 26 +/- 15 min; p < 0.01). Weight, gender, preoperative cardiac catheterization values, and cardiopulmonary bypass time did not differ between the two groups.

RESULTS

Operative mortality was 2.8%, 1 patient in each group (p = 1.0). Over the first 24 hours following operation the mean Fontan pressure, transpulmonary gradient, and common atrial pressure did not differ between LT and ECC patients. The median duration of mechanical ventilation (LT 12 vs ECC 18 hours), intensive care unit stay (LT 2 vs ECC 3 days), chest tube drainage (LT 10 vs ECC 8 days), and hospital stay (LT 11 vs ECC 12 days) did not differ. The ECC patients had a higher incidence of sinus node dysfunction both in the postoperative period (27% vs LT 8%; p = 0.09), and persisting at hospital discharge (10% vs LT 0%; p = 0.02). Mean follow-up was 3.6 +/- 1.6 years in LT, and 3.0 +/- 2.2 years in ECC patients (p = 0.2). There was one late death. Actuarial survival at 5 years is 97% for LT, and 91% for ECC patients (p = 0.4); 96% of patients are in NYHA class I, and 4% in class II, with no difference between groups. Sinus node dysfunction was seen during follow-up in 15% LT vs 28% ECC patients (p = 0.2).

CONCLUSIONS

The LT and ECC approaches had comparable early and mid-term outcomes, including operative morbidity and mortality, postoperative hemodynamics, resource use, and mid-term survival and functional status. ECC patients had a higher incidence of sinus node dysfunction early after operation.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, Pediatric Cardiology, Medical University of South Carolina, Charelston, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

14602257

Citation

Kumar, S Prathap, et al. "Lateral Tunnel Versus Extracardiac Conduit Fontan Procedure: a Concurrent Comparison." The Annals of Thoracic Surgery, vol. 76, no. 5, 2003, pp. 1389-96; discussion 1396-7.
Kumar SP, Rubinstein CS, Simsic JM, et al. Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. Ann Thorac Surg. 2003;76(5):1389-96; discussion 1396-7.
Kumar, S. P., Rubinstein, C. S., Simsic, J. M., Taylor, A. B., Saul, J. P., & Bradley, S. M. (2003). Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. The Annals of Thoracic Surgery, 76(5), 1389-96; discussion 1396-7.
Kumar SP, et al. Lateral Tunnel Versus Extracardiac Conduit Fontan Procedure: a Concurrent Comparison. Ann Thorac Surg. 2003;76(5):1389-96; discussion 1396-7. PubMed PMID: 14602257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lateral tunnel versus extracardiac conduit Fontan procedure: a concurrent comparison. AU - Kumar,S Prathap, AU - Rubinstein,Catherine S, AU - Simsic,Janet M, AU - Taylor,Ashby B, AU - Saul,J Philip, AU - Bradley,Scott M, PY - 2003/11/7/pubmed PY - 2003/12/12/medline PY - 2003/11/7/entrez SP - 1389-96; discussion 1396-7 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 76 IS - 5 N2 - BACKGROUND: The aim of this study was to compare the outcomes of the lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution over the same time period. METHODS: From November 1995 through October 2002, 70 Fontan procedures were performed: 37 LT and 33 ECC. All were fenestrated; 96% were staged with a prior superior cavopulmonary connection. Compared with the ECC patients, the LT patients were younger (2.7 +/- 1.1 vs 3.9 +/- 2.5 years; p = 0.01), had a higher incidence of hypoplastic left heart syndrome (57% vs 21%; p < 0.01), and a longer aortic cross-clamp time (55 +/- 13 vs 26 +/- 15 min; p < 0.01). Weight, gender, preoperative cardiac catheterization values, and cardiopulmonary bypass time did not differ between the two groups. RESULTS: Operative mortality was 2.8%, 1 patient in each group (p = 1.0). Over the first 24 hours following operation the mean Fontan pressure, transpulmonary gradient, and common atrial pressure did not differ between LT and ECC patients. The median duration of mechanical ventilation (LT 12 vs ECC 18 hours), intensive care unit stay (LT 2 vs ECC 3 days), chest tube drainage (LT 10 vs ECC 8 days), and hospital stay (LT 11 vs ECC 12 days) did not differ. The ECC patients had a higher incidence of sinus node dysfunction both in the postoperative period (27% vs LT 8%; p = 0.09), and persisting at hospital discharge (10% vs LT 0%; p = 0.02). Mean follow-up was 3.6 +/- 1.6 years in LT, and 3.0 +/- 2.2 years in ECC patients (p = 0.2). There was one late death. Actuarial survival at 5 years is 97% for LT, and 91% for ECC patients (p = 0.4); 96% of patients are in NYHA class I, and 4% in class II, with no difference between groups. Sinus node dysfunction was seen during follow-up in 15% LT vs 28% ECC patients (p = 0.2). CONCLUSIONS: The LT and ECC approaches had comparable early and mid-term outcomes, including operative morbidity and mortality, postoperative hemodynamics, resource use, and mid-term survival and functional status. ECC patients had a higher incidence of sinus node dysfunction early after operation. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/14602257/Lateral_tunnel_versus_extracardiac_conduit_Fontan_procedure:_a_concurrent_comparison_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003497503010105 DB - PRIME DP - Unbound Medicine ER -