The extracardiac Fontan procedure without cardiopulmonary bypass: Technique and intermediate-term results

Anji T. Yetman, Jonathan Drummond-Webb, William P. Fiser, Michael L. Schmitz, Michiaki Imamura, Sana Ullah, Ryan J. Gunselman, Carl W. Chipman, Charles E. Johnson, Stephen H. Van Devanter

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Abstract

Background. The extracardiac Fontan procedure (ECF) usually requires cardiopulmonary bypass (CPB). In this report, the results and techniques of this procedure without CPB at a single institution are presented. Methods. Between August 1992 and December 2001, ECF without CPB was achieved in 24 of 44 patients undergoing an ECF. Mean age at surgery was 5.9 ± 2.9 years, and mean weight was 20.7 ± 12.6 kg. Diagnoses were tricuspid atresia in 9 patients, single-ventricle with pulmonary outflow tract obstruction in 7, pulmonary atresia/intact septum in 5, and other complex single-ventricle physiology in 3. Initial palliation was by arterial to pulmonary artery shunt in 21 and pulmonary artery banding in 1. A bidirectional cavopulmonary connection was created in 23 patients. A temporary inferior vena caval-to-atrial shunt was used to complete the procedure without CPB. Median graft size was 16 mm (range 14 to 20 mm). Results. There was no early mortality, and 68% of patients were discharged without complications. Complications included persistent cyanosis in 4 patients, persistent pleural effusions in 2 (one chylous), and phrenic nerve injury in 1. Median postoperative hospital stay was 16 days (range 10 to 50) days. At a mean follow-up of 44 ± 28 months, there was no conduit obstruction. One patient died 11 months postoperatively, and 1 patient received a heart transplant 26 months post-ECF. Conclusions. At intermediate term follow-up, the ECF without CPB appears to be safe and technically reproducible in selected cases. Ongoing follow-up of these patients is necessary to document the theoretical advantages of avoiding CPB.

Original languageEnglish (US)
Pages (from-to)1416-1421
Number of pages6
JournalAnnals of Thoracic Surgery
Volume74
Issue number4
StatePublished - Oct 1 2002

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ASJC Scopus subject areas

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

Cite this

Yetman, A. T., Drummond-Webb, J., Fiser, W. P., Schmitz, M. L., Imamura, M., Ullah, S., Gunselman, R. J., Chipman, C. W., Johnson, C. E., & Van Devanter, S. H. (2002). The extracardiac Fontan procedure without cardiopulmonary bypass: Technique and intermediate-term results. Annals of Thoracic Surgery, 74(4), 1416-1421.