Factors related to pleural effusions after Fontan procedure in the era of fenestration

Background-Significant pleural effusions after the Fontan operation prolong hospital stay, may increase the risk of infection, and may necessitate a p leurodesis procedure. Methods and Results-From February 1991 to April 2000, 98 consecutive patien ts under the age of 18 years underwent the fenestrated Fontan procedure at Children's Hospital of Wisconsin. Ninety-four patients who survived at leas t 30 days after surgery were retrospectively evaluated for the following fa ctors: age, ventricular morphology (right single ventricle, left single ven tricle [RV/LV]), fenestration open (FO) or closed (FQ at end of operation. intracardiac Fontan (IF) or extracardiac Fontan (EF), days with chest tube output per day >5, 10, and/or 20 mL . kg(-1) . d(-1) (CTO5, CTO10, and CTO2 0, respectively), need for pleurodesis, length of hospital stay (LOS), oper ation during winter respiratory viral season of November through March (ReV S+, ReVS-), and pre-Fontan mean pulmonary artery pressure (PAP) and pulmona ry vascular resistance (PVR). In univariate analysis, the ReVS+ patients ha d prolonged LOS, greater chest tube output, and more pleurodesis (P <0.05), and PAP was related to CTO5 and CTO10 but not to CTO20 or LOS. No signific ant differences were found in LOS. CTO5, CTO10. CTO20. and need for pleurod esis between patients in RV/LV, FO/FC, IF/EF, or PVR groups. Patients <4 ye ars of age had more instances of CTO20 (P <0.05). When we used ordinary lea st squares regression analysis with age, FO or FC, RV or LV, PAP, and ReVS + or ReVS - to predict each of CTO5. CTO10, CTO20, and LOS, only ReVS + or ReVS - and age were statistically significant in all models. Conclusions-Use of the Fontan procedure during the respiratory viral season appeared to be related to significant, prolonged pleural effusions and lon ger hospitalizations.