Comparison of extracardiac Fontan techniques: Pedicled pericardial tunnel versus conduit reconstruction.
Woods, Ronald K. MD, PhD a; Dyamenahalli, Umesh MD a; Duncan, Brian W. MD b; Rosenthal, Geoffrey L. MD, PhD b; Lupinetti, Flavian M. MD c
[Miscellaneous] Journal of Thoracic & Cardiovascular Surgery. 125(3):465-471, March 2003.

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Objective: This study was designed to determine whether either of 2 alternative methods of extracardiac Fontan reconstruction provides superior results.

Methods: We reviewed 58 consecutive Fontan procedures performed between 1995 and 2001 with a pedicled pericardial tunnel (group P, n = 21) or an extracardiac conduit of polytetrafluoroethylene or allograft aorta (group C, n = 37). Operations were performed with cardiopulmonary bypass at 32[degrees]C; an aortic crossclamp was applied in only 6 patients. All group P patients and 33 (89%) group C patients received fenestrations.

Results: The groups were similar in terms of age, weight, anatomy, and preoperative hemodynamics. There were 3 hospital deaths (5%; 70% confidence limit, 2%-30%), all in group C. Median durations of mechanical ventilation (group P, 1 day; group C, 1 day), intensive care unit stay (group P, 3 days; group C, 3 days), chest tube drainage (group P, 8 days; group C, 7 days), and hospitalization (group P, 10 days; group C, 9 days) were not significantly different. There were no late deaths. All patients received warfarin sodium, and there were no late strokes. Before the Fontan procedure, 1 patient in group P and 3 patients in group C required pacemaker implants. Of the 51 surviving patients in sinus rhythm before the Fontan procedure, only 1 patient in group C subsequently required a pacemaker.

Conclusions: Extracardiac Fontan procedures with either a pericardial baffle or conduit are associated with low operative mortality and low risks of arrhythmia and late thromboembolic complication.

(C) 2003Elsevier, Inc.