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Ann Thorac Surg 2005;80:37-43
© 2005 The Society of Thoracic Surgeons
a Division of Thoracic and Cardiovascular Surgery, Kosair Children’s Hospital, University of Louisville, Louisville, Kentucky
b Division of Pediatric Cardiology, Kosair Children’s Hospital, University of Louisville, Louisville, Kentucky
c Department of Cardiothoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
Accepted for publication January 10, 2005.
* Address reprint requests to Dr Kavarana, Division of Thoracic and Cardiovascular Surgery, 201 Abraham Flexner Way, Suite 1200, Louisville, KY40201 (Email: mkavarana{at}att.net).
Presented at the Fifty-first Annual Meeting of the Southern Thoracic Surgical Association, Cancun, Mexico, Nov 2–4, 2004.
BACKGROUND: Although improved perioperative outcomes with growth potential of the extracardiac pedicled pericardial Fontan (EPPF) operation have been suggested, no advantage has been demonstrated.
METHODS: We retrospectively reviewed our institutional experience of 54 consecutive patients undergoing EPPF between June 1996 and August 2003. Clinical and echocardiographic follow-up was obtained yearly with a mean follow-up of 2.8 ± 2.0 years.
RESULTS: There were 29 males, median age 3.3 years (2–6.8). Median cardiopulmonary bypass time was 79 min (39–295). Fibrillatory arrest was used briefly in 9 patients, of which 6 were for fenestration. One Fontan required takedown (1.8%) and there was 1 death (1.8%) from Candida mediastinitis. Median intensive care unit stay, hospital length of stay, and chest tube drainage were 4 days, 12 days, and 8 days, respectively. Arrhythmias occurred in 7 patients. Three (5.6%) of these had preexisting Holter abnormalities requiring permanent pacemaker implantation. Freedom from thromboembolic events, reoperation, and death at 2.8 years after discharge were 96.2%, 98.1%, and 100%, respectively. All patients were New York Heart Association class I-II, with median oxygen saturation of 94 %. Only 5 patients (9.4%) had mild self-restricted activities. Echocardiographic evaluation revealed excellent ventricular function and flow dynamics.
CONCLUSIONS: At midterm follow-up this technique yields outcomes as good as the other Fontan techniques and with further follow-up may prove to be superior. However, at this point no clear advantage has been demonstrated. The low rate of complications and potential for growth are appealing features of this procedure.
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