The extracardiac Fontan procedure without cardiopulmonary bypass

Technique and intermediate-term results

Angela 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

Research output: Contribution to journalArticle

18 Citations (Scopus)

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

Fingerprint

Fontan Procedure
Cardiopulmonary Bypass
Pulmonary Artery
Tricuspid Atresia
Pulmonary Atresia
Transplants
Venae Cavae
Phrenic Nerve
Cyanosis
Pleural Effusion
Length of Stay
Weights and Measures
Lung
Mortality
Wounds and Injuries

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., ... 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.

The extracardiac Fontan procedure without cardiopulmonary bypass : Technique and intermediate-term results. / Yetman, Angela T; Drummond-Webb, Jonathan; Fiser, William P.; Schmitz, Michael L.; Imamura, Michiaki; Ullah, Sana; Gunselman, Ryan J.; Chipman, Carl W.; Johnson, Charles E.; Van Devanter, Stephen H.

In: Annals of Thoracic Surgery, Vol. 74, No. 4, 01.10.2002, p. 1416-1421.

Research output: Contribution to journalArticle

Yetman, AT, Drummond-Webb, J, Fiser, WP, Schmitz, ML, Imamura, M, Ullah, S, Gunselman, RJ, Chipman, CW, Johnson, CE & Van Devanter, SH 2002, 'The extracardiac Fontan procedure without cardiopulmonary bypass: Technique and intermediate-term results', Annals of Thoracic Surgery, vol. 74, no. 4, pp. 1416-1421.
Yetman AT, Drummond-Webb J, Fiser WP, Schmitz ML, Imamura M, Ullah S et al. The extracardiac Fontan procedure without cardiopulmonary bypass: Technique and intermediate-term results. Annals of Thoracic Surgery. 2002 Oct 1;74(4):1416-1421.
Yetman, Angela T ; Drummond-Webb, Jonathan ; Fiser, William P. ; Schmitz, Michael L. ; Imamura, Michiaki ; Ullah, Sana ; Gunselman, Ryan J. ; Chipman, Carl W. ; Johnson, Charles E. ; Van Devanter, Stephen H. / The extracardiac Fontan procedure without cardiopulmonary bypass : Technique and intermediate-term results. In: Annals of Thoracic Surgery. 2002 ; Vol. 74, No. 4. pp. 1416-1421.
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