ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
S. Prathap Kumar
Scott M. Bradley
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kumar, S. P.
Right arrow Articles by Bradley, S. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kumar, S. P.
Right arrow Articles by Bradley, S. M.
Related Collections
Right arrow Congenital - cyanotic

Ann Thorac Surg 2003;76:1389-1397
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Lateral tunnel versus extracardiac conduit fontan procedure: a concurrent comparison

S. Prathap Kumar, FRCSa, Catherine S. Rubinstein, FNPa, Janet M. Simsic, MDb, Ashby B. Taylor, MDb, J. Philip Saul, MDa, Scott M. Bradley, MD*a

a Division of Cardiothoracic Surgery, Charelston, USA
b Division of Pediatric Cardiology, Medical University of South Carolina, 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, USA
e-mail: bradlesm{at}musc.edu

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.

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 dysfunction 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.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
F. Kerendi, Z. B. Kramer, W. T. Mahle, B. E. Kogon, K. R. Kanter, and P. M. Kirshbom
Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure.
Ann. Thorac. Surg., May 1, 2009; 87(5): 1484 - 1488.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
L. P. Dasi, R. KrishnankuttyRema, H. D. Kitajima, K. Pekkan, K. S. Sundareswaran, M. Fogel, S. Sharma, K. Whitehead, K. Kanter, and A. P. Yoganathan
Fontan hemodynamics: importance of pulmonary artery diameter.
J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 560 - 564.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Ikai, Y. Fujimoto, K. Hirose, N. Ota, Y. Tosaka, T. Nakata, Y. Ide, and K. Sakamoto
Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms.
J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1145 - 1152.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Mavroudis, B. J. Deal, C. L. Backer, R. D. Stewart, W. H. Franklin, S. Tsao, K. M. Ward, and R. A. DeFreitas
111 Fontan Conversions with Arrhythmia Surgery: Surgical Lessons and Outcomes
Ann. Thorac. Surg., November 1, 2007; 84(5): 1457 - 1466.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Nakano, H. Kado, T. Tachibana, K. Hinokiyama, A. Shiose, M. Kajimoto, and Y. Ando
Excellent Midterm Outcome of Extracardiac Conduit Total Cavopulmonary Connection: Results of 126 Cases
Ann. Thorac. Surg., November 1, 2007; 84(5): 1619 - 1626.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Schreiber, J. Horer, M. Vogt, J. Cleuziou, Z. Prodan, and R. Lange
Nonfenestrated Extracardiac Total Cavopulmonary Connection in 132 Consecutive Patients
Ann. Thorac. Surg., September 1, 2007; 84(3): 894 - 899.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
P. Khairy, N. Poirier, and L.-A. Mercier
Univentricular Heart
Circulation, February 13, 2007; 115(6): 800 - 812.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. C. Fiore, M. Turrentine, M. Rodefeld, P. Vijay, T. L. Schwartz, K. S. Virgo, L. K. Fischer, and J. W. Brown
Fontan Operation: A Comparison of Lateral Tunnel with Extracardiac Conduit
Ann. Thorac. Surg., February 1, 2007; 83(2): 622 - 630.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
Y. Tanoue, H. Kado, N. Boku, H. Tatewaki, T. Nakano, K. Fukae, M. Masuda, and R. Tominaga
Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute
Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 97 - 101.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. B. Meyer, G. Zamora, G. Wernovsky, R. F. Ittenbach, P. R. Gallagher, S. Tabbutt, P. J. Gruber, S. C. Nicolson, J. W. Gaynor, and T. L. Spray
Outcomes of the Fontan Procedure Using Cardiopulmonary Bypass with Aortic Cross-Clamping
Ann. Thorac. Surg., November 1, 2006; 82(5): 1611 - 1620.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Giannico, F. Hammad, A. Amodeo, G. Michielon, F. Drago, A. Turchetta, R. Di Donato, and S. P. Sanders
Clinical Outcome of 193 Extracardiac Fontan Patients: The First 15 Years
J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2065 - 2073.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. E. Mitchell, R. F. Ittenbach, J. W. Gaynor, G. Wernovsky, S. Nicolson, and T. L. Spray
Intermediate outcomes after the Fontan procedure in the current era
J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 172 - 180.
[Abstract] [Full Text] [PDF]

Home page
 Crit Care NurseHome page
D. Soetenga and K. A. Mussatto
Management of Infants With Hypoplastic Left Heart Syndrome: Integrating Research Into Nursing Practice
Crit. Care Nurse, December 1, 2004; 24(6): 46 - 66.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. M. Bradley
INVITED COMMENTARY
Ann. Thorac. Surg., December 1, 2004; 78(6): 1988 - 1988.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
S. G. Raja
Interventional atrial incision in the Fontan operation: Novel prophylaxis or iatrogenic substrate for intra-atrial reentrant tachycardia?
J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 325 - 325.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
A. T. Lovell
Anaesthetic implications of grown-up congenital heart disease
Br. J. Anaesth., July 1, 2004; 93(1): 129 - 139.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2003 by The Society of Thoracic Surgeons.