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The modified Fontan procedure with use of extracardiac conduit in adults: analysis of 32 consecutive patients.
Ann Thorac Surg. 2014 Dec; 98(6):2181-6.AT

Abstract

BACKGROUND

Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years.

METHODS

Between January 2003 and December 2013, 32 adult patients (17 female and 15 male) underwent total cavopulmonary connection (TCPC) with extracardiac conduit. The median age at procedure was 24.5 years (interquartile range [IQR] 20 to 33 years). The diagnoses included double-inlet left ventricle (DILV) in 10 patients (31.2%), tricuspid atresia in 8 patients (25%), double-outlet right ventricle in 4 patients (12.5%), heterotaxia in 4 patients (12.5%), and mitral atresia in 2 patients (6.2%). Seventy-eight percent of patients had undergone at least one prior palliative procedure; the most common procedures were Blalock-Taussig shunt (16 patients), superior cavopulmonary shunt (12 patients), and pulmonary artery banding (6 patients). All patients underwent cardiac catheterization preoperatively. Aortic cross-clamping was necessary in 15 patients for intracardiac procedures. Fenestration was required in 9 patients (28%). Four concomitant intraoperative cryoablation procedures were performed.

RESULTS

There was no hospital mortality. One patient (3.1%) died 6 months after undergoing TCPC. Morbidities included prolonged pleural effusion lasting more than 7 days in 20 patients (62.5%), atrial arrhythmias in 4 patients (12.5%), and permanent pacemakers in 3 patients (9.3%). The median follow-up time was 33 months (interquartile range [IQR], 10.5 to 50 months). Actuarial survival was 91.83% (95% confidence limits, 71.07 to 97.89) at 1 year and 5 years. Ninety-two percent of patients were in New York Heart Association class I or II at follow-up. The median postoperative oxygen saturation was 95% (IQR, 93% to 95.5%). Cardiac arrhythmia occurred in 4 patients. Systolic ventricular function improved during follow-up for all patients except 1 patient, who underwent cardiac transplantation 7 months after the TCPC.

CONCLUSIONS

The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up.

Authors+Show Affiliations

Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France. Electronic address: m.ly@ccml.fr.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.Faculty of Medicine, Paris-Sud University, Orsay, France.Department of Congenital Heart Disease, Marie Lannelongue Hospital/M3C, Paris-Sud University, Le Plessis-Robinson, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25443023

Citation

Ly, Mohamedou, et al. "The Modified Fontan Procedure With Use of Extracardiac Conduit in Adults: Analysis of 32 Consecutive Patients." The Annals of Thoracic Surgery, vol. 98, no. 6, 2014, pp. 2181-6.
Ly M, Roubertie F, Kasdi R, et al. The modified Fontan procedure with use of extracardiac conduit in adults: analysis of 32 consecutive patients. Ann Thorac Surg. 2014;98(6):2181-6.
Ly, M., Roubertie, F., Kasdi, R., Chatti, S., Vergnat, M., Luu, D., Le Bret, E., Roussin, R., Capderou, A., & Belli, E. (2014). The modified Fontan procedure with use of extracardiac conduit in adults: analysis of 32 consecutive patients. The Annals of Thoracic Surgery, 98(6), 2181-6. https://doi.org/10.1016/j.athoracsur.2014.07.043
Ly M, et al. The Modified Fontan Procedure With Use of Extracardiac Conduit in Adults: Analysis of 32 Consecutive Patients. Ann Thorac Surg. 2014;98(6):2181-6. PubMed PMID: 25443023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The modified Fontan procedure with use of extracardiac conduit in adults: analysis of 32 consecutive patients. AU - Ly,Mohamedou, AU - Roubertie,François, AU - Kasdi,Reda, AU - Chatti,Sana, AU - Vergnat,Mathieu, AU - Luu,David, AU - Le Bret,Emmanuel, AU - Roussin,Régine, AU - Capderou,André, AU - Belli,Emre, Y1 - 2014/10/28/ PY - 2014/03/20/received PY - 2014/07/03/revised PY - 2014/07/23/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/2/5/medline SP - 2181 EP - 6 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 98 IS - 6 N2 - BACKGROUND: Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years. METHODS: Between January 2003 and December 2013, 32 adult patients (17 female and 15 male) underwent total cavopulmonary connection (TCPC) with extracardiac conduit. The median age at procedure was 24.5 years (interquartile range [IQR] 20 to 33 years). The diagnoses included double-inlet left ventricle (DILV) in 10 patients (31.2%), tricuspid atresia in 8 patients (25%), double-outlet right ventricle in 4 patients (12.5%), heterotaxia in 4 patients (12.5%), and mitral atresia in 2 patients (6.2%). Seventy-eight percent of patients had undergone at least one prior palliative procedure; the most common procedures were Blalock-Taussig shunt (16 patients), superior cavopulmonary shunt (12 patients), and pulmonary artery banding (6 patients). All patients underwent cardiac catheterization preoperatively. Aortic cross-clamping was necessary in 15 patients for intracardiac procedures. Fenestration was required in 9 patients (28%). Four concomitant intraoperative cryoablation procedures were performed. RESULTS: There was no hospital mortality. One patient (3.1%) died 6 months after undergoing TCPC. Morbidities included prolonged pleural effusion lasting more than 7 days in 20 patients (62.5%), atrial arrhythmias in 4 patients (12.5%), and permanent pacemakers in 3 patients (9.3%). The median follow-up time was 33 months (interquartile range [IQR], 10.5 to 50 months). Actuarial survival was 91.83% (95% confidence limits, 71.07 to 97.89) at 1 year and 5 years. Ninety-two percent of patients were in New York Heart Association class I or II at follow-up. The median postoperative oxygen saturation was 95% (IQR, 93% to 95.5%). Cardiac arrhythmia occurred in 4 patients. Systolic ventricular function improved during follow-up for all patients except 1 patient, who underwent cardiac transplantation 7 months after the TCPC. CONCLUSIONS: The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/25443023/The_modified_Fontan_procedure_with_use_of_extracardiac_conduit_in_adults:_analysis_of_32_consecutive_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(14)01617-8 DB - PRIME DP - Unbound Medicine ER -