A Simplified Technique for Interventional Extracardiac Fontan

Prabhu, Sudesh; Anderson, Ben; Ward, Cameron; Karl, Tom R.; Alphonso, Nelson

doi:10.1177/2150135116663697

Cited by 11 publications

(14 citation statements)

References 7 publications

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“…49 Still, it has been shown that interventional creation of a superior cavopulmonary connection with the usage of long covered stents, 39 intervascular connections as the interventional Potts shunt, 50 or interventional completion of Fontan are possible in animals and also in humans. 40,[42][43][44][45][46][47][48]51 The different anatomical features in animals and the nowadays limited availability of endovascular catheter materials make the creation of a solely interventional superior cavopulmonary connection difficult. Most likely, such a procedure will result in a connection between the SVC and the right lower lobe PA, directing most of the blood flow to the right lower lobe.…”

Section: Future Perspectivesmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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BACKGROUND Long-term survival of patients with a single ventricle palliated with a Fontan procedure is still limited. No curative treatment options are available. To investigate the pathophysiology and potential treatment options, such as mechanical circulatory support (MCS), appropriate large animal models are required. The aim of this review was to analyze all full-text manuscripts presenting approaches for an extracardiac total cavopulmonary connection (TCPC) animal model to identify the feasibility and limitations in the acute and chronic setting. METHODS A literature search was performed for fulltext publications presenting large animal models with extracardiac TCPCs on Pubmed and Embase. Out of 454 reviewed papers, 23 manuscripts fulfilled the inclusion criteria. Surgical procedures were categorized and hemodynamic changes at the transition from the biventricular to the univentricular condition analyzed. RESULTS Surgical procedures varied especially regarding coronary venous flow handling and anatomic shape of the TCPC. In most studies (n = 14), the main pulmonary artery was clamped and the coronary venous flow redirected by additional surgical interventions. Only in five reports, the caval veins were connected to the right pulmonary artery to create a true TCPC shape, whereas in all others (n = 18), the veins were connected to the main pulmonary artery. An elevated pulmonary vascular resistance was identified as a limiting hemodynamic factor for TCPC completion in healthy animals. CONCLUSIONS A variety of acute TCPC animal models were successfully established with and without MCS, reflecting the most important hemodynamic features of a Fontan circulation; however, chronic animal models were not reported.

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Section: Future Perspectivesmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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“…Covered stents have a continually expanding spectrum of applications for patient with congenital heart disease. Their use has been described for Fontan completion for over a decade [3][4][5] and there is an established precedent for their use in redirection of blood flow in the setting of complex CHD repair. 6 For this to become a more generalized approach, it will require anticipation and changes to the surgical technique to "setup" for future percutaneous intervention.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter biventricular conversion in an adult patient with a 1.5 ventricle Glenn palliation and superior vena cava syndrome

Tannous

Popescu

Forbess

et al. 2020

Cathet Cardio Intervent

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Covered stents have a continually expanding spectrum of applications for patients with congenital heart disease. Here we report use of covered stents to successfully perform a first‐in‐human percutaneous biventricular conversion of a 1.5 ventricle Glenn palliation in an adult born with pulmonary atresia. This case demonstrates that in patients considered borderline for biventricular repair, surgery can potentially be modified to promote growth of underdeveloped structures and setup for transcatheter biventricular conversion.

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“…2 In 2017, Prabhu and coworkers in Brisbane, Australia, building upon strategies proposed by numerous clinician-investigators as early as the mid-90s, described an innovative procedure to prepare a fiveyear-old patient with single ventricle for eventual completion of the Fontan circulation by means of an interventional catheterization procedure. 1,3 At the time of the Glenn procedure, they sutured a short ePTFE conduit to the right pulmonary artery and another longer graft to the IVC. A large medial opening made in the lower conduit was anastomosed side-to-side to a right atriotomy.…”

Section: Commentmentioning

confidence: 99%

The Kawashima Operation With Simultaneous Preparation for Transcatheter Fontan-Kreutzer Completion

Lugones

Junco

Biancolini

et al. 2019

World J Pediatr Congenit Heart Surg

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Patients with functionally single ventricle and interrupted inferior vena cava may develop progressive cyanosis soon after the Kawashima operation. Therefore, early redirection of the hepatic venous return to the pulmonary circulation is recommended. To avoid performing an early redo sternotomy, we propose to prepare these patients for the interventional Fontan-Kreutzer at the time of the Kawashima operation using a technical modification of the approach reported by Prabhu and coworkers in 2017. The technique described here uses an expanded polytetrafluoroethylene conduit interposed between the hepatic veins and the right pulmonary artery. This graft is everted and divided into two portions with a pericardial patch. The lower one is widely opened and anastomosed side-to-side to the atrium. A few months after the operation, percutaneous Fontan-Kreutzer completion can easily be performed using covered stents to open the patch and at the same time close the opening between the conduit and the atrium.

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A Simplified Technique for Interventional Extracardiac Fontan

Abstract: Our technique of interventional Fontan, anatomically and hemodynamically, mimics a standard ECF procedure.

Cited by 11 publications

References 7 publications

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Transcatheter biventricular conversion in an adult patient with a 1.5 ventricle Glenn palliation and superior vena cava syndrome

The Kawashima Operation With Simultaneous Preparation for Transcatheter Fontan-Kreutzer Completion

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