Lateral Tunnel Versus Extracardiac Conduit Fontan Procedure: A Concurrent Comparison

S. Prathap Kumar, Catherine S. Rubinstein, Janet M. Simsic, Ashby B. Taylor, J. Philip Saul, Scott M. Bradley, Erle H. Austin, W. Steves Ring

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

Background. The aim of this study was to compare the outcomes of the lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution over the same time period. Methods. From November 1995 through October 2002, 70 Fontan procedures were performed: 37 LT and 33 ECC. All were fenestrated; 96% were staged with a prior superior cavopulmonary connection. Compared with the ECC patients, the LT patients were younger (2.7 ± 1.1 vs 3.9 ± 2.5 years; p = 0.01), had a higher incidence of hypoplastic left heart syndrome (57% vs 21%; p < 0.01), and a longer aortic cross-clamp time (55 ± 13 vs 26 ± 15 min; p < 0.01). Weight, gender, preoperative cardiac catheterization values, and cardiopulmonary bypass time did not differ between the two groups. Results. Operative mortality was 2.8%, 1 patient in each group (p = 1.0). Over the first 24 hours following operation the mean Fontan pressure, transpulmonary gradient, and common atrial pressure did not differ between LT and ECC patients. The median duration of mechanical ventilation (LT 12 vs ECC 18 hours), intensive care unit stay (LT 2 vs ECC 3 days), chest tube drainage (LT 10 vs ECC 8 days), and hospital stay (LT 11 vs ECC 12 days) did not differ. The ECC patients had a higher incidence of sinus node dysfunction both in the postoperative period (27% vs LT 8%; p = 0.09), and persisting at hospital discharge (10% vs LT 0%; p = 0.02). Mean follow-up was 3.6 ± 1.6 years in LT, and 3.0 ± 2.2 years in ECC patients (p = 0.2). There was one late death. Actuarial survival at 5 years is 97% for LT, and 91% for ECC patients (p = 0.4); 96% of patients are in NYHA class I, and 4% in class II, with no difference between groups. Sinus node ysfunction was seen during follow-up in 15% LT vs 28% ECC patients (p = 0.2). Conclusions. The LT and ECC approaches had comparable early and mid-term outcomes, including operative morbidity and mortality, postoperative hemodynamics, resource use, and mid-term survival and functional status. ECC patients had a higher incidence of sinus node dysfunction early after operation.

Original languageEnglish (US)
Pages (from-to)1389-1397
Number of pages9
JournalAnnals of Thoracic Surgery
Volume76
Issue number5
DOIs
StatePublished - Nov 2003

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Kumar, S. P., Rubinstein, C. S., Simsic, J. M., Taylor, A. B., Saul, J. P., Bradley, S. M., Austin, E. H., & Ring, W. S. (2003). Lateral Tunnel Versus Extracardiac Conduit Fontan Procedure: A Concurrent Comparison. Annals of Thoracic Surgery, 76(5), 1389-1397. https://doi.org/10.1016/S0003-4975(03)01010-5