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Fontan operation: a comparison of lateral tunnel with extracardiac conduit.
Ann Thorac Surg. 2007 Feb; 83(2):622-9; discussion 629-30.AT

Abstract

BACKGROUND

The purpose of this report is to compare the outcome of the extracardiac (EC) with the lateral tunnel (LT) Fontan.

METHODS

From January 1990 to October 2004, the Fontan operation was performed in 162 patients, of which 49 were EC and 113 were LT. Cardiac morphology and ventricular dominance were similar, except EC patients were older and had a greater frequency of heterotaxy syndrome, and LT patients had a higher incidence of hypoplastic left heart syndrome. Preoperative transpulmonary gradient, ventricular end-diastolic pressure, McGoon index, room air saturation, and cardiac rhythm were similar. EC patients underwent superior caval pulmonary connection, and LT patients underwent hemi-Fontan. Cardiopulmonary bypass time was similar, but fewer EC patients needed aortic cross-clamping. Fenestration was more frequent in LT patients (EC, 16% versus LT, 73%; p < 0.01).

RESULTS

Overall operative mortality was 1.8% (EC, 1 versus LT, 2; p = NS). Postoperative transpulmonary gradient, readmission for chylous effusion, and change in ejection fraction relative to preoperative level did not differ between cohorts. Resource utilization was higher in the EC group. The loss of sinus rhythm and the frequency of all neurologic events did not differ. There were seven late deaths (EC 4 versus LT 3; p = NS). Actuarial survival at 5 years was not significantly different (EC, 90% versus LT, 95%; p = 0.08).

CONCLUSIONS

The EC and LT operation had comparable early and late mortality, readmission for chylous effusion, preservation of sinus rhythm, and frequency of all neurologic events. The more frequently fenestrated LT cohort used fewer resources.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, St. Louis University School of Medicine/Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA. fiorem2@slu.eduNo 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

17257998

Citation

Fiore, Andrew C., et al. "Fontan Operation: a Comparison of Lateral Tunnel With Extracardiac Conduit." The Annals of Thoracic Surgery, vol. 83, no. 2, 2007, pp. 622-9; discussion 629-30.
Fiore AC, Turrentine M, Rodefeld M, et al. Fontan operation: a comparison of lateral tunnel with extracardiac conduit. Ann Thorac Surg. 2007;83(2):622-9; discussion 629-30.
Fiore, A. C., Turrentine, M., Rodefeld, M., Vijay, P., Schwartz, T. L., Virgo, K. S., Fischer, L. K., & Brown, J. W. (2007). Fontan operation: a comparison of lateral tunnel with extracardiac conduit. The Annals of Thoracic Surgery, 83(2), 622-9; discussion 629-30.
Fiore AC, et al. Fontan Operation: a Comparison of Lateral Tunnel With Extracardiac Conduit. Ann Thorac Surg. 2007;83(2):622-9; discussion 629-30. PubMed PMID: 17257998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fontan operation: a comparison of lateral tunnel with extracardiac conduit. AU - Fiore,Andrew C, AU - Turrentine,Mark, AU - Rodefeld,Mark, AU - Vijay,Palaniswamy, AU - Schwartz,Theresa L, AU - Virgo,Katherine S, AU - Fischer,Laurice K, AU - Brown,John W, PY - 2005/03/01/received PY - 2006/09/18/revised PY - 2006/09/19/accepted PY - 2007/1/30/pubmed PY - 2007/3/7/medline PY - 2007/1/30/entrez SP - 622-9; discussion 629-30 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 83 IS - 2 N2 - BACKGROUND: The purpose of this report is to compare the outcome of the extracardiac (EC) with the lateral tunnel (LT) Fontan. METHODS: From January 1990 to October 2004, the Fontan operation was performed in 162 patients, of which 49 were EC and 113 were LT. Cardiac morphology and ventricular dominance were similar, except EC patients were older and had a greater frequency of heterotaxy syndrome, and LT patients had a higher incidence of hypoplastic left heart syndrome. Preoperative transpulmonary gradient, ventricular end-diastolic pressure, McGoon index, room air saturation, and cardiac rhythm were similar. EC patients underwent superior caval pulmonary connection, and LT patients underwent hemi-Fontan. Cardiopulmonary bypass time was similar, but fewer EC patients needed aortic cross-clamping. Fenestration was more frequent in LT patients (EC, 16% versus LT, 73%; p < 0.01). RESULTS: Overall operative mortality was 1.8% (EC, 1 versus LT, 2; p = NS). Postoperative transpulmonary gradient, readmission for chylous effusion, and change in ejection fraction relative to preoperative level did not differ between cohorts. Resource utilization was higher in the EC group. The loss of sinus rhythm and the frequency of all neurologic events did not differ. There were seven late deaths (EC 4 versus LT 3; p = NS). Actuarial survival at 5 years was not significantly different (EC, 90% versus LT, 95%; p = 0.08). CONCLUSIONS: The EC and LT operation had comparable early and late mortality, readmission for chylous effusion, preservation of sinus rhythm, and frequency of all neurologic events. The more frequently fenestrated LT cohort used fewer resources. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17257998/Fontan_operation:_a_comparison_of_lateral_tunnel_with_extracardiac_conduit_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(06)01895-9 DB - PRIME DP - Unbound Medicine ER -