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| In-Situ Pericardial Extracardiac Lateral Tunnel Fontan Operation: Fifteen-year Experience |
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Nahidh W. Hasaniya, Anees J. Razzouk, Leonard L. Bailey; Cardiothoracic Suregery, Loma Linda University Medical Cneter, Loma Linda, CA Objective: To evaluate the long term outcome of in-situ pericardial extra-cardiac lateral tunnel (ECLT) Fontan operation in a single institution. Methods: From June 1994 to August 2009, 160 patients (n=96, 60% males, median age=39 months, mean weight 15.5 K gm) underwent completion Fontan using pedicled pericardial ECLT. Patients charts were reviewed for peri-operative and long term follow up data and outcome. The potential growth of these tunnels were evaluated with echocardiography. Results: The main primary diagnoses were: Tricuspid atresia (n=44, 27%); Double outlet right ventricle (n=29, 18%); hypoplastic left heart syndrome (n=26, 16%) and Double inlet left ventricle (n=20, 12.5%). All operations used cardiopulmonary bypass (median 126 min). Concomitant procedures included: atrial septectomy (n=24, 15%), pulmonary arterioplasty (n=6, 3.7%), and repair of atrioventricular valve (n=2,1.2%). Fenestration was performed in (3, 1.8%) patients. All patients were placed on aspirin post-operatively and no anticoagulants were used. The mean follow up was 6.5±3.7 (range 0.1 to 15) years. There were 2 operative (1.2%) and 6 (3.7%) late deaths . Actuarial survival at 14 years was 90%. Average hospital stay was 4.2 days. Early complications included: prolonged effusions (n=49, 31%); chylothorax (n=7, 4.4%); re-admissions (n=35, 22%); cerebrovascular accidents (n=8, 5%); left phrenic nerve palsy (n=1, 0.8%); transient arrhythmias (n=5, 3.1%). No patient required pace-maker secondary to this operation. Late complications included: Tunnel stenosis (n=3, 1.8%) managed successfully with balloon dilatation and senting in 2 and surgical revision in 1 patient; tunnel thrombosis (n=2, 1.2%) both patients died; protein losing enteropathy (n=4, 2.5%). Follow up echocardiography of 10 patients showed laminar flow with no turbulence or gradient at the inferior vena cava and mid-tunnel levels. The diameter indexed to body surface area showed growth, reduction or no change depending on the flow demands. Conclusion: We believe that ECLT Fontan operation using in-situ pericardial flap should be the procedure of choice in most single ventricle patients . This operation is technically feasible with minimal intermediate and late complications and mortality. It is the most cost effective live conduit that has a low incidence of arrhythmias and thrombosis, and has potential to adjust dimensions to flow requirements. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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