Tags

Type your tag names separated by a space and hit enter

Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience.
Eur J Cardiothorac Surg. 2013 May; 43(5):952-7.EJ

Abstract

OBJECTIVES

The use of modified extracardiac Fontan operation (ECFO) for total cavo-pulmonary connection allows cardiopulmonary bypass (CPB) to be avoided and seems to improve early postoperative results. We evaluated our experience with the off-pump technique for ECFO.

METHODS

Since 2009, the last 17 consecutive patients of 137 (median age 3.2 years, median weight 14.5 kg) in whom no intracardiac surgery was necessary underwent ECFO without CPB. The non-fenestrated graft was connected end-to-side to the pulmonary artery without bypass; subsequently temporary passive inferior vena cava (IVC)-to-atrial bypass was used for the anastomosis between IVC and graft. The perioperative and postoperative course was compared between consecutive paediatric patients operated on using the CPB vs off-pump technique.

RESULTS

There was no mortality in the off-pump group, with a total early mortality of 3.0%. Overall operation time for the Fontan operation using the off-pump technique was significantly reduced (160 vs 200 min, P < 0.001). The median Fontan pressure 24 and 48 h postoperatively was significantly lower in the off-pump group (P = 0.002/0.042). Duration of mechanical ventilation (9 vs 14 h, P = 0.016), pleural effusions (4 vs 8 days, P < 0.001) as well as the median intensive care unit (2 vs 4 days, P = 0.013) and hospital stay (median 10 vs 15 days, P < 0.001) was significantly shorter in patients who underwent the off-pump Fontan operation. The necessity of blood transfusions was significantly reduced with the off-pump in comparison with the on-pump technique (14 of 17 vs 34 of 84 patients, P = 0.003).

CONCLUSIONS

The ECFO without CPB is an established low-risk surgical procedure that improves the early postoperative course and significantly reduces the use of blood products and the duration of pleural effusions in selected patients.

Authors+Show Affiliations

Department of Congenital Heart Diseases, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Berlin, Germany. ovroutski@dhzb.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23111560

Citation

Ovroutski, Stanislav, et al. "Improved Early Postoperative Outcome for Extracardiac Fontan Operation Without Cardiopulmonary Bypass: a Single-centre Experience." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, vol. 43, no. 5, 2013, pp. 952-7.
Ovroutski S, Sohn C, Miera O, et al. Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience. Eur J Cardiothorac Surg. 2013;43(5):952-7.
Ovroutski, S., Sohn, C., Miera, O., Peters, B., Alexi-Meskishvili, V., Hetzer, R., Berger, F., & Hübler, M. (2013). Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 43(5), 952-7. https://doi.org/10.1093/ejcts/ezs535
Ovroutski S, et al. Improved Early Postoperative Outcome for Extracardiac Fontan Operation Without Cardiopulmonary Bypass: a Single-centre Experience. Eur J Cardiothorac Surg. 2013;43(5):952-7. PubMed PMID: 23111560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience. AU - Ovroutski,Stanislav, AU - Sohn,Christian, AU - Miera,Oliver, AU - Peters,Björn, AU - Alexi-Meskishvili,Vladimir, AU - Hetzer,Roland, AU - Berger,Felix, AU - Hübler,Michael, Y1 - 2012/10/29/ PY - 2012/11/1/entrez PY - 2012/11/1/pubmed PY - 2013/11/19/medline SP - 952 EP - 7 JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg VL - 43 IS - 5 N2 - OBJECTIVES: The use of modified extracardiac Fontan operation (ECFO) for total cavo-pulmonary connection allows cardiopulmonary bypass (CPB) to be avoided and seems to improve early postoperative results. We evaluated our experience with the off-pump technique for ECFO. METHODS: Since 2009, the last 17 consecutive patients of 137 (median age 3.2 years, median weight 14.5 kg) in whom no intracardiac surgery was necessary underwent ECFO without CPB. The non-fenestrated graft was connected end-to-side to the pulmonary artery without bypass; subsequently temporary passive inferior vena cava (IVC)-to-atrial bypass was used for the anastomosis between IVC and graft. The perioperative and postoperative course was compared between consecutive paediatric patients operated on using the CPB vs off-pump technique. RESULTS: There was no mortality in the off-pump group, with a total early mortality of 3.0%. Overall operation time for the Fontan operation using the off-pump technique was significantly reduced (160 vs 200 min, P < 0.001). The median Fontan pressure 24 and 48 h postoperatively was significantly lower in the off-pump group (P = 0.002/0.042). Duration of mechanical ventilation (9 vs 14 h, P = 0.016), pleural effusions (4 vs 8 days, P < 0.001) as well as the median intensive care unit (2 vs 4 days, P = 0.013) and hospital stay (median 10 vs 15 days, P < 0.001) was significantly shorter in patients who underwent the off-pump Fontan operation. The necessity of blood transfusions was significantly reduced with the off-pump in comparison with the on-pump technique (14 of 17 vs 34 of 84 patients, P = 0.003). CONCLUSIONS: The ECFO without CPB is an established low-risk surgical procedure that improves the early postoperative course and significantly reduces the use of blood products and the duration of pleural effusions in selected patients. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/23111560/Improved_early_postoperative_outcome_for_extracardiac_Fontan_operation_without_cardiopulmonary_bypass:_a_single_centre_experience_ L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezs535 DB - PRIME DP - Unbound Medicine ER -