Introduction:
There are conflicting reports regarding the two current techniques of Fontan completion. This report evaluates the outcome in 33 consecutive cases of Extracardiac Fontan operation in a single centre.
Patients and Methods:
During 1999-2008, 33 patients (M:F=19:14; Median age= 9.5 years, range 5 to 29 years) underwent extracardiac Fontan procedure for univentricular physiology. The diagnostic categories are shown in diagram 1. 28 patients had prior superior cavopulmonary anastomosis. The median preoperative SPO2 was 77 + 8.2%. The mean PA pressure was 8 + 3.2 mm of Hg. The operation consisted of connecting the intra-pericardial IVC to the PA using a conduit (Gore-tex tube-31, median size- 22mm) with a fenestration to the RA performed on the beating heart under normothermic perfusion.
Results:
The immediate post-operative outcome is shown in table 1. All patients received warfarin for the first year, and subsequently warfarin and/or aspirin. On follow up (n=30, median duration -14 months, range =4 – 108 months), all patients were in functional class 1 or 2. There was no mortality. SPO2 at last follow up was 92 + 7.6%. All patients, including 5 with >60 months follow-up, in preoperative sinus rhythm continued to be so. Three patients had asymptomatic SVT. There were no “Fontan failures”, thrombo-embolic episodes, or protein-losing enteropathy. No patient required fenestration closure or conduit revision.
Conclusion:
Extracardiac Fontan operation can be performed in univentricular hearts with excellent functional outcome in the short and intermediate term.