Parameters associated with perioperative baffle fenestration closure in the Fontan operation

Objective: To identify clinical parameters indicating perioperative fenestr ation closure in children who underwent the fenestrated Fontan operation. Design: Retrospective. Setting: Single children's hospital. Participants: Patients who underwent a fenestrated Fontan operation in 1996 through 1997 (n = 101). Intervention:A fenestrated Fontan operation was performed in children with single-ventricle physiology. Measurements and Main Results: Early perioperative closure of the fenestrat ion occurred in 14 patients (group 1). whereas the fenestration remained pa tent in 87 patients (group 2). The groups were compared by the following pa rameters: demographics, cardiac catheterization and ultrasound data, and us e of aspirin or warfarin preoperatively and intraoperatively by assessing t he composition of the cardiopulmonary bypass solution, use of ultrafiltrati on and antifibrinolytics, protamine dose, last hematocrit on cardiopulmonar y bypass, and requirement of blood products. Immediately postoperatively in the intensive care unit (ICU), cardiac filling pressures (central venous a nd left atrial pressure), coagulation profile, cardiac rhythm, chest tube d rainage, length of stay in the ICU, and use of atrial pacing were reviewed. Significant indicators of early fenestration closure in this study as dete rmined by multivariate stepwise logistic regression were a high transpulmon ary pressure gradient (p = 0.015) and a higher oxygen saturation (p = 0.001 ) 1 hour after arrival in the ICU, a low fibrinogen level (p < 0.0001), and the need for temporary atrial pacing (p = 0.029). The fenestration was reo pened in 13 patients in group 1. In 101 patients, there was no early mortal ity, and all patients survived to discharge. Conclusion: Factors that correlated with postoperative fenestration closure in the fenestrated Fontan operation in this study were a high transpulmona ry pressure gradient and a high oxygen saturation 1 hour after arrival in t he ICU, a low fibrinogen level, and the need for temporary atrial pacing. C opyright (C) 2000 by W.B. Saunders Company.