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Ann Thorac Surg 2001;72:408-415
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Aortopulmonary collateral flow in the Fontan patient: does it matter?

Scott M. Bradley, MDa, Mary M. McCall, CCPb, Joseph J. Sistino, CCPb, Wolfgang A.K. Radtke, MDc

a Division of Cardiothoracic Surgery, Charleston, South Carolina, USA
b Extracorporeal Circulation Technology Program, Medical University of South Carolina, Charleston, South Carolina, USA
c Division of Pediatric Cardiology, Charleston, South Carolina, USA

Address reprint requests to Dr Bradley, Division of Cardiothoracic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425
e-mail: bradlesm{at}musc.edu

Presented at the Forty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.

Background. The effects of aortopulmonary collaterals (APCs) on the outcome of a Fontan procedure are unclear. We undertook this study to define the incidence and extent of APC flow, identify risk factors for APC flow, and determine if APC flow has a measurable effect on the outcome of a Fontan procedure.

Methods. The APC flow was directly measured in 32 patients undergoing Fontan procedures from July 1997 to September 2000. The APC flow was measured in the operating room during total cardiopulmonary bypass, and was expressed as a percentage of total bypass pump flow.

Results. The APC flow ranged from 9% to 49% of total pump flow (median, 18%). Higher preoperative systemic oxygen saturation, pulmonary artery oxygen saturation, pulmonary to systemic flow ratio, and angiographic APC grade correlated with higher APC flow. There were no operative deaths; there was one Fontan takedown (APC flow = 14%). The APC flow had no significant effects on postoperative Fontan pressure, common atrial pressure, transpulmonary gradient, duration of effusions, or resource utilization after the Fontan procedures.

Conclusions. In patients undergoing a Fontan procedure, APC flow is omnipresent, although its extent varies widely. Increased APC flow has no significant effect on the outcome of a Fontan procedure. This conclusion applies to patients who are well prepared for a Fontan procedure, but may not extend to patients at higher risk.




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