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Extracardiac Fontan conversion, cryoablation, and pacemaker placement for patients with a failed Fontan.
Semin Thorac Cardiovasc Surg. 2005 Summer; 17(2):170-8.ST

Abstract

OBJECTIVE

We review our experience with Fontan conversion and cryoablation in patients with an atriopulmonary Fontan in low cardiac output from arrhythmia or venous obstruction, including two patients with protein losing enteropathy.

METHODS

Fifteen patients (mean age 25.0 +/- 8.4 years) underwent extracardiac Fontan conversion, cryoablation, and pacemaker placement between November 1999 and December 2004. Twelve patients were in NYHA class III and three were in NYHA class IV. Twelve had clinically important intraatrial reentry tachycardia refractory to medical therapy.

RESULTS

Follow-up was between 2 and 62 months (mean 38.4 +/- 17.7). One death occurred at seven days after surgery due to sepsis and multisystem organ failure. The second death occurred at five days from myocardial depression following surgery. One patient with PLE preoperatively died to malnutrition and sepsis on POD number 52. The second patient with protein losing enteropathy had improved NYHA classification, cessation of albumin transfusions, and a normal stool alpha antitrypsin level (down from 4.1 mg/g preoperatively). All surviving patients improved NYHA classification to class I or II. Sustained arrhythmias could not be induced in any patient. One patient had recurrence of intraatrial reentrant tachycardia eleven months postoperatively that required electrical cardioversion and is currently well controlled on one medication. The other patients are not on any antiarrhythmic medical therapy.

CONCLUSION

Extracardiac Fontan, cryoablation, and pacemaker placement reduced atrial arrhythmias and improved NYHA classification. In selected patients, this operation offers improvement in clinical outcome and is an alternative to transplantation. Protein losing enteropathy may not be a contraindication to performing Fontan conversion with cryoablation.

Authors+Show Affiliations

Division of Pediatric Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York 10467, USA. sweinste@montefiore.orgNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16087088

Citation

Weinstein, Samuel, and David Chan. "Extracardiac Fontan Conversion, Cryoablation, and Pacemaker Placement for Patients With a Failed Fontan." Seminars in Thoracic and Cardiovascular Surgery, vol. 17, no. 2, 2005, pp. 170-8.
Weinstein S, Chan D. Extracardiac Fontan conversion, cryoablation, and pacemaker placement for patients with a failed Fontan. Semin Thorac Cardiovasc Surg. 2005;17(2):170-8.
Weinstein, S., & Chan, D. (2005). Extracardiac Fontan conversion, cryoablation, and pacemaker placement for patients with a failed Fontan. Seminars in Thoracic and Cardiovascular Surgery, 17(2), 170-8.
Weinstein S, Chan D. Extracardiac Fontan Conversion, Cryoablation, and Pacemaker Placement for Patients With a Failed Fontan. Semin Thorac Cardiovasc Surg. 2005;17(2):170-8. PubMed PMID: 16087088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracardiac Fontan conversion, cryoablation, and pacemaker placement for patients with a failed Fontan. AU - Weinstein,Samuel, AU - Chan,David, PY - 2005/8/10/pubmed PY - 2005/12/21/medline PY - 2005/8/10/entrez SP - 170 EP - 8 JF - Seminars in thoracic and cardiovascular surgery JO - Semin Thorac Cardiovasc Surg VL - 17 IS - 2 N2 - OBJECTIVE: We review our experience with Fontan conversion and cryoablation in patients with an atriopulmonary Fontan in low cardiac output from arrhythmia or venous obstruction, including two patients with protein losing enteropathy. METHODS: Fifteen patients (mean age 25.0 +/- 8.4 years) underwent extracardiac Fontan conversion, cryoablation, and pacemaker placement between November 1999 and December 2004. Twelve patients were in NYHA class III and three were in NYHA class IV. Twelve had clinically important intraatrial reentry tachycardia refractory to medical therapy. RESULTS: Follow-up was between 2 and 62 months (mean 38.4 +/- 17.7). One death occurred at seven days after surgery due to sepsis and multisystem organ failure. The second death occurred at five days from myocardial depression following surgery. One patient with PLE preoperatively died to malnutrition and sepsis on POD number 52. The second patient with protein losing enteropathy had improved NYHA classification, cessation of albumin transfusions, and a normal stool alpha antitrypsin level (down from 4.1 mg/g preoperatively). All surviving patients improved NYHA classification to class I or II. Sustained arrhythmias could not be induced in any patient. One patient had recurrence of intraatrial reentrant tachycardia eleven months postoperatively that required electrical cardioversion and is currently well controlled on one medication. The other patients are not on any antiarrhythmic medical therapy. CONCLUSION: Extracardiac Fontan, cryoablation, and pacemaker placement reduced atrial arrhythmias and improved NYHA classification. In selected patients, this operation offers improvement in clinical outcome and is an alternative to transplantation. Protein losing enteropathy may not be a contraindication to performing Fontan conversion with cryoablation. SN - 1043-0679 UR - https://www.unboundmedicine.com/medline/citation/16087088/Extracardiac_Fontan_conversion_cryoablation_and_pacemaker_placement_for_patients_with_a_failed_Fontan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1043-0679(05)00009-2 DB - PRIME DP - Unbound Medicine ER -