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Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure.
J Card Surg. 2011 Sep; 26(5):509-14.JC

Abstract

OBJECTIVE

Factors related to prolonged pleural drainage after the Fontan operation have not been clearly defined. We investigated perioperative variables to establish factors predicting operative morbidity including prolonged chest tube drainage. Also, we pursued the fate of the fenestration during the follow-up period.

METHODS

We retrospectively reviewed 52 patients who had undergone a fenestrated extracardiac Fontan procedure between August 1998 and June 2008. The median age at the time of surgery was 34.8 (range: 18.5 ∼ 156) months and the median body weight 13.2 kg (range: 9.5 ∼ 33). A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables for postoperative morbidity.

RESULTS

Operative mortality occurred in one patient (1.9%). The mean duration of respiratory support, chest tube drainage, and hospital stay was 13 hours (range: 4 to 328 hours), six days (range: 2 to 45 days), and 16 days (range: 7 to 444 days), respectively. Statistically, an operation without previous bidirectional cavopulmonary shunt (OR 30, 95% CI 3.1 to 289) was the only independent risk factor for prolonged pleural drainage. Aortic cross-clamp time was identified as a risk factor for prolonged mechanical ventilatory support. During a median follow-up at 62 months (range: 17 to 137 months), there was one late death (1.9%). Twenty-two patients (43%) underwent intervention for fenestration closure.

CONCLUSIONS

Previous bidirectional cavopulmonary shunt and shortened aortic cross-clamp time may reduce postoperative morbidity including prolonged chest tube drainage and mechanical ventilator support after the fenestrated extracardiac conduit Fontan procedure.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.No 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

21848579

Citation

Kim, Su Wan, et al. "Omission of a Prior Glenn Anastomosis Is a Risk Factor for Prolonged Pleural Drainage After the Fenestrated Extracardiac Conduit Fontan Procedure." Journal of Cardiac Surgery, vol. 26, no. 5, 2011, pp. 509-14.
Kim SW, Jun TG, Yang JH, et al. Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure. J Card Surg. 2011;26(5):509-14.
Kim, S. W., Jun, T. G., Yang, J. H., Park, P. W., Kang, I. S., Huh, J., Hurh, J., & Lee, H. J. (2011). Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure. Journal of Cardiac Surgery, 26(5), 509-14. https://doi.org/10.1111/j.1540-8191.2011.01291.x
Kim SW, et al. Omission of a Prior Glenn Anastomosis Is a Risk Factor for Prolonged Pleural Drainage After the Fenestrated Extracardiac Conduit Fontan Procedure. J Card Surg. 2011;26(5):509-14. PubMed PMID: 21848579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure. AU - Kim,Su Wan, AU - Jun,Tae-Gook, AU - Yang,Ji-Hyuk, AU - Park,Pyo Won, AU - Kang,I-Seok, AU - Huh,June, AU - Hurh,June, AU - Lee,Heung-Jae, Y1 - 2011/08/18/ PY - 2011/8/19/entrez PY - 2011/8/19/pubmed PY - 2012/2/1/medline SP - 509 EP - 14 JF - Journal of cardiac surgery JO - J Card Surg VL - 26 IS - 5 N2 - OBJECTIVE: Factors related to prolonged pleural drainage after the Fontan operation have not been clearly defined. We investigated perioperative variables to establish factors predicting operative morbidity including prolonged chest tube drainage. Also, we pursued the fate of the fenestration during the follow-up period. METHODS: We retrospectively reviewed 52 patients who had undergone a fenestrated extracardiac Fontan procedure between August 1998 and June 2008. The median age at the time of surgery was 34.8 (range: 18.5 ∼ 156) months and the median body weight 13.2 kg (range: 9.5 ∼ 33). A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables for postoperative morbidity. RESULTS: Operative mortality occurred in one patient (1.9%). The mean duration of respiratory support, chest tube drainage, and hospital stay was 13 hours (range: 4 to 328 hours), six days (range: 2 to 45 days), and 16 days (range: 7 to 444 days), respectively. Statistically, an operation without previous bidirectional cavopulmonary shunt (OR 30, 95% CI 3.1 to 289) was the only independent risk factor for prolonged pleural drainage. Aortic cross-clamp time was identified as a risk factor for prolonged mechanical ventilatory support. During a median follow-up at 62 months (range: 17 to 137 months), there was one late death (1.9%). Twenty-two patients (43%) underwent intervention for fenestration closure. CONCLUSIONS: Previous bidirectional cavopulmonary shunt and shortened aortic cross-clamp time may reduce postoperative morbidity including prolonged chest tube drainage and mechanical ventilator support after the fenestrated extracardiac conduit Fontan procedure. SN - 1540-8191 UR - https://www.unboundmedicine.com/medline/citation/21848579/Omission_of_a_prior_Glenn_anastomosis_is_a_risk_factor_for_prolonged_pleural_drainage_after_the_fenestrated_extracardiac_conduit_Fontan_procedure_ L2 - https://doi.org/10.1111/j.1540-8191.2011.01291.x DB - PRIME DP - Unbound Medicine ER -