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Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit.
Ann Thorac Surg. 2005 Oct; 80(4):1445-51; discussion 1451-2.AT

Abstract

BACKGROUND

Since Fontan revision has been demonstrated to provide hemodynamic and symptomatic improvement in select patients with failing Fontan circulations, we now believe it is important to determine if one type of revision (lateral tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes.

METHODS

Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS). Twenty-eight patients (80%) underwent a modified maze procedure (LT = 12 vs ECC = 16, p = NS) and 29 (83%) had pacemaker placement (LT = 11 vs ECC = 18, p < 0.05).

RESULTS

There were no hospital deaths and no arrhythmias at hospital discharge. There were no differences in mean duration of intubation (LT 0.6 vs ECC 0.9 days, p = NS), inotropic support (LT 1.5 vs ECC 2.1 days, p = NS), intensive care unit stay (LT 2.6 vs ECC 3.5 days, p = NS), hospital stay (LT 8.8 vs ECC 9.7 days, p = NS), or episodes of acute postoperative arrhythmias (LT = 2 vs ECC = 4, p = NS). On intermediate follow-up (29 +/- 22 months), the overall cohort had 94% survival, 97% of survivors in NYHA class I/II, 91% freedom from late arrhythmias requiring medication, and no patient required cardiac transplantation. Follow-up revealed no differences in NYHA I/II (LT = 14 vs ECC = 18, p = NS), mortality (LT = 2 vs ECC = 0, p = NS), or late arrhythmia (LT = 4 vs ECC = 4, p = NS).

CONCLUSIONS

Both the LT and ECC revisions provide symptomatic benefit for a failing Fontan connection and have equivalent early and intermediate results including arrhythmia recurrence.

Authors+Show Affiliations

Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA. dlmorale@texaschildrenshospital.orgNo affiliation info availableNo affiliation info availableNo 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

16181885

Citation

Morales, David L S., et al. "Salvaging the Failing Fontan: Lateral Tunnel Versus Extracardiac Conduit." The Annals of Thoracic Surgery, vol. 80, no. 4, 2005, pp. 1445-51; discussion 1451-2.
Morales DL, Dibardino DJ, Braud BE, et al. Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit. Ann Thorac Surg. 2005;80(4):1445-51; discussion 1451-2.
Morales, D. L., Dibardino, D. J., Braud, B. E., Fenrich, A. L., Heinle, J. S., Vaughn, W. K., McKenzie, E. D., & Fraser, C. D. (2005). Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit. The Annals of Thoracic Surgery, 80(4), 1445-51; discussion 1451-2.
Morales DL, et al. Salvaging the Failing Fontan: Lateral Tunnel Versus Extracardiac Conduit. Ann Thorac Surg. 2005;80(4):1445-51; discussion 1451-2. PubMed PMID: 16181885.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit. AU - Morales,David L S, AU - Dibardino,Daniel J, AU - Braud,Brandi E, AU - Fenrich,Arnold L, AU - Heinle,Jeffrey S, AU - Vaughn,William K, AU - McKenzie,E Dean, AU - Fraser,Charles D,Jr PY - 2005/01/20/received PY - 2005/03/26/revised PY - 2005/03/28/accepted PY - 2005/9/27/pubmed PY - 2006/9/20/medline PY - 2005/9/27/entrez SP - 1445-51; discussion 1451-2 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 80 IS - 4 N2 - BACKGROUND: Since Fontan revision has been demonstrated to provide hemodynamic and symptomatic improvement in select patients with failing Fontan circulations, we now believe it is important to determine if one type of revision (lateral tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes. METHODS: Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS). Twenty-eight patients (80%) underwent a modified maze procedure (LT = 12 vs ECC = 16, p = NS) and 29 (83%) had pacemaker placement (LT = 11 vs ECC = 18, p < 0.05). RESULTS: There were no hospital deaths and no arrhythmias at hospital discharge. There were no differences in mean duration of intubation (LT 0.6 vs ECC 0.9 days, p = NS), inotropic support (LT 1.5 vs ECC 2.1 days, p = NS), intensive care unit stay (LT 2.6 vs ECC 3.5 days, p = NS), hospital stay (LT 8.8 vs ECC 9.7 days, p = NS), or episodes of acute postoperative arrhythmias (LT = 2 vs ECC = 4, p = NS). On intermediate follow-up (29 +/- 22 months), the overall cohort had 94% survival, 97% of survivors in NYHA class I/II, 91% freedom from late arrhythmias requiring medication, and no patient required cardiac transplantation. Follow-up revealed no differences in NYHA I/II (LT = 14 vs ECC = 18, p = NS), mortality (LT = 2 vs ECC = 0, p = NS), or late arrhythmia (LT = 4 vs ECC = 4, p = NS). CONCLUSIONS: Both the LT and ECC revisions provide symptomatic benefit for a failing Fontan connection and have equivalent early and intermediate results including arrhythmia recurrence. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/16181885/Salvaging_the_failing_Fontan:_lateral_tunnel_versus_extracardiac_conduit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)00572-2 DB - PRIME DP - Unbound Medicine ER -