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David L.S. Morales
Jeffrey S. Heinle
E. Dean McKenzie
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Ann Thorac Surg 2005;80:1445-1452
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Salvaging the Failing Fontan: Lateral Tunnel Versus Extracardiac Conduit

David L.S. Morales, MD a , * , Daniel J. Dibardino, MD a , Brandi E. Braud a , Arnold L. Fenrich, MD b , Jeffrey S. Heinle, MD a , William K. Vaughn, PhD c , E. Dean McKenzie, MD a , Charles D. Fraser, Jr, MD a

a Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Texas Heart Institute, Baylor College of Medicine, Houston, Texas
b Department of Pediatrics, Division of Pediatric Cardiology, Texas Heart Institute, Baylor College of Medicine, Houston, Texas
c Section of Biostatistics and Epidemiology, Texas Heart Institute, Baylor College of Medicine, Houston, Texas

Accepted for publication March 28, 2005.

* Address reprint requests to Dr Morales, Division of Congenital Heart Surgery, Texas Children's Hospital, 6621 Fannin St, WT-19345H, Houston, TX 77030 (Email: dlmorale{at}texaschildrenshospital.org).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Since Fontan revision has been demonstrated to provide hemodynamic and symptomatic improvement in select patients with failing Fontan circulations, we now believe it is important to determine if one type of revision (lateral tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes.

METHODS: Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS). Twenty-eight patients (80%) underwent a modified maze procedure (LT = 12 vs ECC = 16, p = NS) and 29 (83%) had pacemaker placement (LT = 11 vs ECC = 18, p < 0.05).

RESULTS: There were no hospital deaths and no arrhythmias at hospital discharge. There were no differences in mean duration of intubation (LT 0.6 vs ECC 0.9 days, p = NS), inotropic support (LT 1.5 vs ECC 2.1 days, p = NS), intensive care unit stay (LT 2.6 vs ECC 3.5 days, p = NS), hospital stay (LT 8.8 vs ECC 9.7 days, p = NS), or episodes of acute postoperative arrhythmias (LT = 2 vs ECC = 4, p = NS). On intermediate follow-up (29 ± 22 months), the overall cohort had 94% survival, 97% of survivors in NYHA class I/II, 91% freedom from late arrhythmias requiring medication, and no patient required cardiac transplantation. Follow-up revealed no differences in NYHA I/II (LT = 14 vs ECC = 18, p = NS), mortality (LT = 2 vs ECC = 0, p = NS), or late arrhythmia (LT = 4 vs ECC = 4, p = NS).

CONCLUSIONS: Both the LT and ECC revisions provide symptomatic benefit for a failing Fontan connection and have equivalent early and intermediate results including arrhythmia recurrence.




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