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The Annals of Thoracic Surgery, Vol 52, 189-196, Copyright © 1991 by The Society of Thoracic Surgeons
JM Pearl, H Laks, DG Stein, DC Drinkwater, BL George and RG Williams
The total cavopulmonary anastomosis, lateral tunnel Fontan, has been
advocated as a preferred method for Fontan type repair. From 1987 to July
1990, 39 patients underwent total cavopulmonary anastomoses (group 1) and
39 patients underwent modified Fontan procedures (group 2); patients
receiving adjustable atrial septal defects were excluded. Diagnoses in
group 1 included tricuspid atresia in 5 patients, single ventricle in 32,
and pulmonary atresia and intact ventricular septum in 2. Diagnoses in
group 2 included tricuspid atresia in 20, single ventricle in 17,
hypoplastic left heart syndrome in 1, and pulmonary atresia and intact
ventricular septum in 1. There were no significant differences in age,
weight, cross-clamp time, duration of inotropic support, postoperative
effusions, or hospital stay between the two groups. Early mortality in
group 1 was 7.7% (3/39) and in group 2, 2.6% (1/39). There was no
difference in the incidence of early dysrhythmias or early pacemaker
placement. Late mortality was 2.8% in group 1 and 8% in group 2 with a mean
follow-up of 18 and 25 months, respectively. Follow-up in group 1 revealed
33 patients in normal sinus rhythm and 1 patient with episodes of
supraventricular tachycardia; no additional patients have required
pacemakers. Follow-up in group 2 revealed 27 patients in normal sinus
rhythm and supraventricular tachycardia in 4 patients; 5 additional
patients have required pacemaker placement. There is no apparent difference
in early outcome between the total cavopulmonary anastomosis and the
conventional modified Fontan. However, there appears to be an increased
incidence of late dysrhythmias and the need for pacemaker placement in the
conventional modified Fontan group compared with the lateral tunnel group.
ARTICLES
Total cavopulmonary anastomosis versus conventional modified Fontan procedure
University of California, Los Angeles.
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