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Indian Journal of Thoracic and Cardiovascular Surgery

Published in:

01-09-2013 | Review Article

Extra cardiac Fontan without cardiopulmonary bypass: techniques and early results

Authors: Sachin Talwar, Subramanian Muthukkumaran, Neeti Makhija, Suruchi Hasija, Palleti Rajashekar, Shiv Kumar Choudhary, Balram Airan

Published in: Indian Journal of Thoracic and Cardiovascular Surgery | Issue 3/2013

Abstract

Extracardiac Fontan is currently the preferred final palliation for patients with a univentricular heart. The operation is commonly performed on Cardiopulmonary bypass on a beating heart. In this review, we discuss a protocol for successfully performing this operation without cardiopulmonary bypass. The advantages and pitfalls of this technique are briefly discussed.

De Leval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg. 1988;96:682–95.PubMed

Knott-Craig CJ, Danielson GK, Schaff HV, Puga FJ, Weaver AL, Driscoll DD. The modified Fontan operation. An analysis of risk factors for early postoperative death or takedown in 702 consecutive patients from one institution. J Thorac Cardiovasc Surg. 1995;109:1237–43.PubMedCrossRef

Kirklin JW, Barratt-Boyes BG. Tricuspid atresia and the Fontan operation. In: Kirklin JW, Barratt-Boyes BG, editors. Cardiac surgery, vol. 2. 2nd ed. New York: Churchill Livingstone; 1993. p. 1055–104.

Gentles TL, Mayer Jr JE, Gauvreau K, et al. Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg. 1997;114:376–91.PubMedCrossRef

Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971;26:240–8.PubMedCrossRef

Kreutzer G, Galíndez E, Bono H, De Palma C, Laura JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg. 1973;66:613–21.PubMed

Mayer Jr JE. Late outcome after the Fontan procedure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 1998;1:5–8.PubMed

Stamm C, Friehs I, Mayer Jr JE, et al. Long-term results of the lateral tunnel Fontan operation. J Thorac Cardiovasc Surg. 2001;121:28–41.PubMedCrossRef

Marcelletti C, Corno A, Giannico S, Marino B. Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg. 1990;100:228–32.PubMed

10.

Petrossian E, Reddy VM, McElhinney DB, et al. Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg. 1999;117:688–96.PubMedCrossRef

11.

Marcelletti CF, Iorio FS, Abella RF. Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 1999;2:131–41.PubMed

12.

Tokunaga S, Kado H, Imoto Y, et al. Total cavopulmonary connection with an extracardiac conduit: Experience with 100 patients. Ann Thorac Surg. 2002;73:76–8.PubMedCrossRef

13.

Schreiber C, Hörer J, Vogt M, Cleuziou J, Prodan Z, Lange R. Nonfenestrated extracardiac total cavopulmonary connection in 132 consecutive patients. Ann Thorac Surg. 2007;84:894–9.PubMedCrossRef

14.

Jonas RA. The intra/extracardiac conduit fenestrated fontan. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14:11–8.PubMedCrossRef

15.

Lardo AC, Webber SA, Friehs I, del Nido PJ, Cape EG. Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections. J Thorac Cardiovasc Surg. 1999;117:697–704.PubMedCrossRef

16.

Gelatt M, Hamilton RM, McCrindle BW, et al. Risk factors for atrial tachyarrhythmias after the Fontan operation. J Am Coll Cardiol. 1994;24:1735–41.PubMedCrossRef

17.

Nakano T, Kado H, Ishikawa S, et al. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method. J Thorac Cardiovasc Surg. 2004;127:730–7.PubMedCrossRef

18.

Azakie A, McCrindle BW, Van Arsdell G, et al. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg. 2001;122:1219–28.PubMedCrossRef

19.

Backer CL, Deal BJ, Kaushal S, Russell HM, Tsao S, Mavroudis C. Extracardiac versus intra-atrial lateral tunnel fontan: extracardiac is better. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2011;14:4–10.PubMedCrossRef

20.

McElhinney DB, Petrossian E, Reddy VM, Hanley FL. Extracardiac conduit Fontan procedure without cardiopulmonary bypass. Ann Thorac Surg. 1998;66:1826–8.PubMedCrossRef

21.

Uemura H, Yagihara T, Yamashita K, Ishizaka T, Yoshizumi K, Kawahira Y. Establishment of total cavopulmonary connection without use of cardiopulmonary bypass. Eur J Cardiothorac Surg. 1998;13:504–7.PubMedCrossRef

22.

Petrossian E, Reddy VM, Collins KK, et al. The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J Thorac Cardiovasc Surg. 2006;132:1054–63.PubMedCrossRef

23.

Okabe H, Nagata N, Kaneko Y, Kobayashi J, Kanemoto S, Takaoka T. Extracardiac cavopulmonary connection of fontan procedure with autologous pedicled pericardium without cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1998;116:1073–5.PubMedCrossRef

24.

Shiraishi S, Uemura H, Kagisaki K, Koh M, Yagihara T, Kitamura S. The off-pump Fontan procedure by simply cross-clamping the inferior caval vein. Ann Thorac Surg. 2005;79:2083–7.PubMedCrossRef

25.

Shinkawa T, Anagnostopoulos PV, Johnson NC, et al. Early results of the “clamp and sew” Fontan procedure without the use of circulatory support. Ann Thorac Surg. 2011;91:1453–9.PubMedCrossRef

26.

Seghaye MC, Grabitz RG, Duchateau J, et al. Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations. J Thorac Cardiovasc Surg. 1996;112:687–97.PubMedCrossRef

27.

Koutlas TC, Gaynor JW, Nicolson SC, Steven JM, Wernovsky G, Spray TL. Modified ultrafiltration reduces postoperative morbidity after cavopulmonary connection. Ann Thorac Surg. 1997;64:37–42.PubMedCrossRef

28.

Tárnok A, Hambsch J, Emmrich F, et al. Complement activation, cytokines, and adhesion molecules in children undergoing cardiac surgery with or without cardiopulmonary bypass. Pediatr Cardiol. 1999;20:113–25.PubMedCrossRef

29.

Maehara T, Novak I, Wyse RK, Elliot MJ. Perioperative monitoring of total body water by bio-electrical impedance in children undergoing open heart surgery. Eur J Cardiothorac Surg. 1991;5:258–64.PubMedCrossRef

30.

Kawahira Y, Uemura H, Yagihara T. Impact of the off-pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg. 2006;81:685–9.PubMedCrossRef

31.

Phornphutkul C, Rosenthal A, Nadas AS, Berenberg W. Cerebrovascular accidents in infants and children with cyanotic congenital heart disease. Am J Cardiol. 1973;32:329.PubMedCrossRef

32.

Tempe DK, Virmani S. Coagulation abnormalities in patients with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth. 2002;16:752–65.PubMedCrossRef

33.

Schulte-Sasse U, Hess W, Tarnow J. Pulmonary vascular responses to nitrous oxide in patients with normal and high pulmonary vascular resistance. Anesthesiology. 1982;57:9–13.PubMedCrossRef

34.

Rivenes SM, Lewin MB, Stayer SA, et al. Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease: anechocardiographic study of myocardial contractility and hemodynamics. Anesthesiology. 2001;94(2):223–9.PubMedCrossRef

35.

Laird TH, Stayer SA, Rivenes SM, et al. Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane, and fentanyl/midazolam in children with congenital heart disease. Anesth Analg. 2002;95:1200–6.PubMedCrossRef

36.

Bösenberg A. Neuraxial blockade and cardiac surgery in children. Paediatr Anaesth. 2003;13:559–60.PubMedCrossRef

37.

Talwar S, Sharma P, Kumar TKS, Choudhary SK, Gharde P, Airan B. Bidirectional superior cavo-pulmonary anastomosis without cardiopulmonary bypass. Indian J Thorac Cardiovasc Surg. 2008;24:269–76.CrossRef

38.

Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226–35.PubMedCrossRef

39.

Abarbanell GL, Goldberg CS, Devaney EJ, Ohye RG, Bove EL, Charpie JR. Early surgical morbidity and mortality in adults with congenital heart disease: the University of Michigan experience. Congenit Heart Dis. 2008;3:82–9.PubMedCrossRef

40.

Yetman AT, Drummond-Webb J, Fiser WP, et al. The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results. Ann Thorac Surg. 2002;74:S1416–21.PubMedCrossRef

41.

Shikata F, Yagihara T, Kagisaki K, et al. Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Eur J Cardiothorac Surg. 2008;34:570–5.PubMedCrossRef

42.

McCammond AN, Kuo K, Parikh VN, et al. Early outcomes after extracardiac conduit Fontan operation without cardiopulmonary bypass. Pediatr Cardiol. 2012;33:1078–85.PubMedCrossRef

43.

Navabi MA, Rastegar SM, Kiani A, et al. Avoiding cardiopulmonary bypass in extracardiac cavopulmonary connection:does it really matter? J Thorac Cardiovasc Surg. 2010;139:1183–8.PubMedCrossRef

Title: Extra cardiac Fontan without cardiopulmonary bypass: techniques and early results
Authors: Sachin Talwar
Subramanian Muthukkumaran
Neeti Makhija
Suruchi Hasija
Palleti Rajashekar
Shiv Kumar Choudhary
Balram Airan
Publication date: 01-09-2013
Publisher: Springer India
Published in: Indian Journal of Thoracic and Cardiovascular Surgery / Issue 3/2013
Print ISSN: 0970-9134
Electronic ISSN: 0973-7723
DOI: https://doi.org/10.1007/s12055-013-0229-x

2024 ASCO Annual Meeting

Springer Medicine

Extra cardiac Fontan without cardiopulmonary bypass: techniques and early results

Abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

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