Open Access

ARTICLE

A Single Institution’s Experience with Later Extracardiac Fontan Procedure Off Bypass

by Carter Biewen^1,*, Hitendra Patel², Olaf Reinhartz³, Ginny Gildengorin⁴, Natalie Cvijanovich⁵

1 Division of Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, 98105, USA
2 Division of Pediatric Cardiology, UCSF Benioff Children’s Hospital Oakland, Oakland, 94609, USA
3 Department of Cardiothoracic Surgery—Pediatric Cardiac Surgery, Stanford University, Stanford, 94305, USA
4 Children’s Hospital Oakland Research Institute, Oakland, 94609, USA
5 Division of Pediatric Critical Care Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, 94609, USA

* Corresponding Author: Carter Biewen. Email:

Congenital Heart Disease 2020, 15(4), 229-238. https://doi.org/10.32604/CHD.2020.011671

Received 25 May 2020; Accepted 11 August 2020; Issue published 07 September 2020

Abstract

Purpose: To summarize Fontan procedure data from our institution, UCSF Benioff Children’s Hospital Oakland, in order to better understand outcomes of our surgical and post-operative care. Basic Procedures: This is a retrospective cross-sectional chart review summarizing characteristics and outcomes of patients who underwent the Fontan procedure at our institution between 2005 and 2016. Main Findings: Sixty-five Fontan procedures were performed at our institution between 2005 and 2016, all of which were extracardiac Fontan procedures performed by the same surgical team. At the time of Fontan procedure, the mean patient age was 56.4 ± 18.7 months and mean weight was 16.6 ± 2.7 kg. There was no significant correlation appreciated between patient age/weight and outcomes. Six (9%) Fontan conduits were fenestrated. Thirty-eight (58%) Fontan procedures were performed off cardiopulmonary bypass. Fontan procedures performed off bypass and of shorter duration were associated with fewer days to extubation and pressor discontinuation post-operatively, as well as higher discharge SpO2. Two patients (3%) required Fontan conduit takedown during their post-operative ICU stays. The most common complications were pleural effusion, chylothorax, arrhythmia and infection. There was no early or late mortality. Principle Conclusions: Delayed extracardiac Fontan procedure off cardiopulmonary bypass appears to be a safe and effective approach. The strategy may provide benefit when considering certain outcomes, however more studies are needed to further elucidate these findings.

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Keywords

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