Early results of the extracardiac conduit Fontan operation

Background: Among the modifications of the Fontan operation, the extracardi ac approach may offer the greatest potential for optimizing early postopera tive ventricular and pulmonary vascular function, insofar as it can be perf ormed with short periods of normothermic partial cardiopulmonary bypass and without cardioplegic arrest in most cases. In this study, we reviewed our experience with the extracardiac conduit Fontan operation, with a focus on early postoperative outcomes. Methods and results: Between July 1992 and Ap ril 1997, 51 patients (median age 4.9 years) underwent an extracardiac cond uit Fontan operation. Median cardiopulmonary bypass time was 92 minutes and has decreased significantly over the course of our experience. Intracardia c procedures were performed in only 5 patients (10%), and the aorta was cro ssclamped in only 11 (22%). Intraoperative fenestration was performed in 24 patients (47%). There were no early deaths. Fontan failure occurred in 1 p atient who was a poor candidate for the Fontan procedure. Transient suprave ntricular tachyarrhythmias occurred in 5 patients (10%). Median duration of chest tube drainage was 8 days. Factors significantly associated with prol onged resource use (mechanical ventilation, inotropic support, intensive ca re unit stay, and hospital stay) included longer bypass time and higher Fon tan pressure. At a median follow-up of 1.9 years, there was 1 death from bl eeding at reoperation. Conclusions: The extracardiac conduit Fontan procedu re can be performed with minimal mortality and morbidity, Improved results may be related to advantages of the extracardiac approach and improved pres ervation of ventricular and pulmonary vascular function.