Synthetic antifibrinolytics are not associated with an increased incidenceof baffle fenestration closure after the modified Fontan procedure

Objective: To determine if the lysine analog antifibrinolytic agents, E-ami nocaproic acid and tranexamic acid, are associated with early closure of th e baffle fenestration after the modified Fontan procedure. Design: Retrospective chart review. Setting: University hospital. Participants: Seventy-four successive patients underwent the modified Fonta n procedure. Three patients received aprotinin and were excluded. A total o f 71 patients were analyzed. Interventions: Charts were examined for variables known to be associated wi th baffle fenestration closure in the modified Fontan procedure. Measurements and Main Results: Occurrence of baffle fenestration closure, o xygen saturation, central venous pressure, left atrial pressure, transpulmo nary gradient, chest tube drainage volume, chest tube drainage duration, in tensive care unit (ICU) duration, and total inpatient duration were compare d between the 33 patients who received antifibrinolytics and the 38 patient s who did not. One patient of 71 had baffle fenestration closure in the fir st 48 hours after surgery. Oxygen saturation, central venous pressure, left atrial pressure, transpulmonary gradient, chest tube drainage volume, ches t tube drainage duration, days in ICU, and total inpatient duration were no t significantly different between the two groups. Conclusions: Use of E-aminocaproic acid and tranexamic acid is not associat ed with early baffle fenestration closure after the modified Fontan procedu re. It is concluded that these agents can be used without increasing the ri sk of spontaneous baffle fenestration closure. Copyright (C) 2000 by W.B. S aunders Company.