Medical Results of One-stage Fontan Procedure in 116 Patients at A Single Institute_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUWei , LIUJin-fen , XUZhi-wei , ZHANGHai-bo , ZHENGJing-hao , ZHUZhong-qun , YANQin , WANGShun-min , QIULi-sheng , ZHUHong-bing , LUYa-nan ,  CHENHui-wen

Department of Pediatric Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P. R. China;

Corresponding author：

CHENHui-wen, Email: hwhwhc@hotmail.com

Keywords：

Total cavopulmonary connection; Fontan procedure; One-stage procedure; Functional single ventricular

DOI：

10.7507/1007-4848.20160032

Video：

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Objective To analyze the outcomes of patients with one-stage Fontan procedure and short-term prognosis at a single institute. Method We retrospectively analyzed clinical records of 116 patients with one-stage Fontan procedure in our hospital from January 2008 through September 2013. There were 77 males and 39 females (36%), with median age 6.27 years (ranged 3.15 to 17.47 years) at the time of surgery and the median weight at 17.5 kg (ranged 10.0 to 80.0 kg). There were 55 patients with standard extracardiac conduit, 13 patients with direct extracardiac connection, 17 patients with intra-atrial or intra/extracardiac conduit, and 31 patients with lateral tunnel. Results Median cardiopulmonary bypass time was 124 (61-256) minutes. Median cross-clamp time was 60 (19-152) minutes. There were six early deaths (5.1%). The overall median time of the cardiac intensive care unit stay was 4 (1-17) days, with a median ventilator support of 7.3 (1.0-181.0) hours. The mean room air saturation was 90.00%±4.68% before discharge. Median length of chest tube drainage was 10 (4-45) days. Multiple logistic analysis confirmed that heterotaxy syndrome was the only independent predictor for postoperative renal insufficiency. Operations with aortic cross-clamping (OR=26.184, 95% CI 1.712-400.451), preoperative sinus mode dysfunction (OR=6.777, 95% CI 1.495-30.721) and cross-clamp time over 60 minutes (OR=1.036, 95% CI 1.002-1.076) were predictors for prolonged chest tube drainage. A total of 110 patients were followed up for 17 (8-47) months with 2 deaths and 1 with thrombosis. No reoperation occurred. Conclusion The one-stage Fontan procedure can be performed with satisfactory outcomes. Staged strategies for operations may be appropriately loosen for selected elder children.

Citation： LIUWei, LIUJin-fen, XUZhi-wei, ZHANGHai-bo, ZHENGJing-hao, ZHUZhong-qun, YANQin, WANGShun-min, QIULi-sheng, ZHUHong-bing, LUYa-nan, CHENHui-wen. Medical Results of One-stage Fontan Procedure in 116 Patients at A Single Institute. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 142-146. doi: 10.7507/1007-4848.20160032 Copy

1.	Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3): 240-248.
2.	Jonas RA. The intra/extracardiac conduit fenestrated Fontan. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2011, 14(1): 11-18.
3.	Hsu DT, Quaegebeur JM, Ing FF, et al. Outcome after the single-stage, nonfenestrated Fontan procedure. Circulation, 1997, 96(9 Suppl): Ⅱ-335-340.
4.	Clark BJ, Sleeper IA, Anderson PA, et al. The Fontan cross-sectional study: testing for correlations among health-related quality of life, maximal exercise performance, and ventricular mass to volume ratio. Circulation, 2004, 110(supp1):HI 441.(Abstract).
5.	Robbers-Visser D, Miedema M, Nijveld A, et al. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg, 2010, 37(4): 934-941.
6.	Meyer DB, Zamora G, Wernovsky G, et al. Outcomes of the Fontan procedure using cardiopulmonary bypass with aortic cross-clamping. Ann Thorac Surg, 2006, 82(5): 1611-1620.
7.	Wolff D, van Melle JP, Ebels T, et al. Trends in mortality (1975-2011) after one-and two-stage Fontan surgery, including bidirectional Glenn through Fontan completion. Eur J Cardiothorac Surg, 2014, 45(4): 602-609.
8.	Lytrivi ID, Sfyridis PG, Papagiannis J, et al. Impact of age at fontan completion on functional status at mid-term follow up. Hellenic J Cardiol, 2011, 52(2): 118-122.
9.	Banka P, Sleeper LA, Atz AM, et al. Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Am Heart J, 2011, 162(1): 125-130.
10.	Kim SJ. Heterotaxy syndrome. Korean Circ J, 2011, 41(5): 227-232.
11.	Eronen MP, Aittomaki KA, Kajantie EO, et al. Outcome of left atrial isomerism at a single institution. Pediatr Cardiol, 2012, 33(4): 596-600.
12.	Eronen MP, Aittomaki KA, Kajantie EO, et al. The outcome of patients with right atrial isomerism is poor. Pediatr Cardiol, 2013, 34(2): 302-307.
13.	Francois K, Bove T, De Groote K, et al. Pleural effusions, water balance mediators and the influence of lisinopril after completion Fontan procedures. Eur J Cardiothorac Surg, 2009, 36(1): 57-62.
14.	Kim SW, Jun TG, Yang JH, et al. Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure. J Card Surg, 2011, 26(5): 509-514.
15.	Gupta A, Daggett C, Behera S, et al. Risk factors forpersistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg, 2004, 127(6):1664-1669.
16.	Francois K, Bove T, De Groote K, et al. Pleural effusions, water balance mediators and the influence of lisinopril after completion Fontan procedures. Eur J Cardiothorac Surg, 2009, 36(1): 57-62.
17.	Korkut AK, Cetin G, Soyler I, et al. Pleural effusion and off-pump Fontan procedure. J Thorac Cardiovasc Surg, 2004, 128(5): 799.
18.	Shikata F, Yagihara T, Kagisaki K, et al. Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Eur J Cardiothorac Surg, 2008, 34(3): 570-575.
19.	Kogon B. Is the extracardiac conduit the preferred fontan approach for patients with univentricular hearts? the extracardiac conduit is the preferred Fontan approach for patients with univentricular hearts. Circulation, 2012, 126(21): 2511-2515.
20.	Chen H, Hong H, Zhu Z, et al. Extracardiac Fontan with direct cavopulmonary connections: midterm results. Eur J Cardiothorac Surg, 2013, 43(2): 318-323.

1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3): 240-248.
2. Jonas RA. The intra/extracardiac conduit fenestrated Fontan. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2011, 14(1): 11-18.
3. Hsu DT, Quaegebeur JM, Ing FF, et al. Outcome after the single-stage, nonfenestrated Fontan procedure. Circulation, 1997, 96(9 Suppl): Ⅱ-335-340.
4. Clark BJ, Sleeper IA, Anderson PA, et al. The Fontan cross-sectional study: testing for correlations among health-related quality of life, maximal exercise performance, and ventricular mass to volume ratio. Circulation, 2004, 110(supp1):HI 441.(Abstract).
5. Robbers-Visser D, Miedema M, Nijveld A, et al. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg, 2010, 37(4): 934-941.
6. Meyer DB, Zamora G, Wernovsky G, et al. Outcomes of the Fontan procedure using cardiopulmonary bypass with aortic cross-clamping. Ann Thorac Surg, 2006, 82(5): 1611-1620.
7. Wolff D, van Melle JP, Ebels T, et al. Trends in mortality (1975-2011) after one-and two-stage Fontan surgery, including bidirectional Glenn through Fontan completion. Eur J Cardiothorac Surg, 2014, 45(4): 602-609.
8. Lytrivi ID, Sfyridis PG, Papagiannis J, et al. Impact of age at fontan completion on functional status at mid-term follow up. Hellenic J Cardiol, 2011, 52(2): 118-122.
9. Banka P, Sleeper LA, Atz AM, et al. Practice variability and outcomes of coil embolization of aortopulmonary collaterals before Fontan completion: a report from the Pediatric Heart Network Fontan Cross-Sectional Study. Am Heart J, 2011, 162(1): 125-130.
10. Kim SJ. Heterotaxy syndrome. Korean Circ J, 2011, 41(5): 227-232.
11. Eronen MP, Aittomaki KA, Kajantie EO, et al. Outcome of left atrial isomerism at a single institution. Pediatr Cardiol, 2012, 33(4): 596-600.
12. Eronen MP, Aittomaki KA, Kajantie EO, et al. The outcome of patients with right atrial isomerism is poor. Pediatr Cardiol, 2013, 34(2): 302-307.
13. Francois K, Bove T, De Groote K, et al. Pleural effusions, water balance mediators and the influence of lisinopril after completion Fontan procedures. Eur J Cardiothorac Surg, 2009, 36(1): 57-62.
14. Kim SW, Jun TG, Yang JH, et al. Omission of a prior Glenn anastomosis is a risk factor for prolonged pleural drainage after the fenestrated extracardiac conduit Fontan procedure. J Card Surg, 2011, 26(5): 509-514.
15. Gupta A, Daggett C, Behera S, et al. Risk factors forpersistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg, 2004, 127(6):1664-1669.
16. Francois K, Bove T, De Groote K, et al. Pleural effusions, water balance mediators and the influence of lisinopril after completion Fontan procedures. Eur J Cardiothorac Surg, 2009, 36(1): 57-62.
17. Korkut AK, Cetin G, Soyler I, et al. Pleural effusion and off-pump Fontan procedure. J Thorac Cardiovasc Surg, 2004, 128(5): 799.
18. Shikata F, Yagihara T, Kagisaki K, et al. Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Eur J Cardiothorac Surg, 2008, 34(3): 570-575.
19. Kogon B. Is the extracardiac conduit the preferred fontan approach for patients with univentricular hearts? the extracardiac conduit is the preferred Fontan approach for patients with univentricular hearts. Circulation, 2012, 126(21): 2511-2515.
20. Chen H, Hong H, Zhu Z, et al. Extracardiac Fontan with direct cavopulmonary connections: midterm results. Eur J Cardiothorac Surg, 2013, 43(2): 318-323.

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Medical Results of One-stage Fontan Procedure in 116 Patients at A Single Institute

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