Comparison of the fenestrated and non-fenestrated Fontan procedures

Li, Dongxu; Li, Mengsi; Zhou, Xu; An, Qi

doi:10.1097/md.0000000000016554

Cited by 21 publications

(23 citation statements)

References 30 publications

(60 reference statements)

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“…9 Ventilation time has similarly been studied; however, only a few patients have been examined, and the conclusions were unclear. 10 In a study by Salazar et al, similar to our study, ventilation time was extended in the fenestration group. 11 Our results suggest that fenestration may be a predictor Cardiology in the Young of prolonged ventilation in the short term, but further data collection is needed.…”

Section: Discussionsupporting

confidence: 83%

Risk factors for prolonged ventilation after the modified Fontan procedure

et al. 2021

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Objective: To investigate the risk factors associated with prolonged ventilation after Fontan surgery. Design: Retrospective case series. Setting: Tertiary childrens hospital. Patients: We included 123 children who underwent Fontan surgery without delayed sternal closure or extracorporeal membrane oxygenation between 2011 and 2017. Intervention: Fontan surgery. Measurements and main results: Prolonged ventilation was defined as intubation for more than 24 hours after surgery. Preoperative, intraoperative, and perioperative data were collected retrospectively from medical records. Multivariate logistic regression analysis was used to identify risk factors for prolonged ventilation. The median age and weight of patients were 2.2 years and 10.0 kg, respectively. Seventeen per cent of the patients (n = 21) received prolonged mechanical ventilation, and the median intubation period was 2.9 days. There were no 90-day or in-hospital deaths. The independent predictors of prolonged ventilation identified were fenestration (p < 0.01), low pulmonary artery index (p = 0.02), and advanced atrioventricular regurgitation (p < 0.01). The duration of ICU stay was significantly longer in the prolonged ventilation group than in the early extubation group (10 days versus 6 days, p < 0.01). Conclusion: Fenestration, low pulmonary artery index, and significant atrioventricular regurgitation are risk factors for prolonged ventilation after Fontan surgery. Careful preoperative and perioperative management that considers the risk factors for prolonged ventilation in each individual is important.

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Section: Discussionsupporting

confidence: 83%

Risk factors for prolonged ventilation after the modified Fontan procedure

et al. 2021

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“…We did not encounter any stroke or conduit thrombosis in our patient group. Li et al 42 compared the long‐term results of fenestration on systemic oxygen saturation in a meta‐analysis including 1929 Fontan patients and reported that although the early postoperative SaO 2 was lower in fenestrated patients, the late postoperative SaO 2 levels did not differ. Therefore, some centers insist on routine fenestration in all Fontan patients, but we still decide individually depending on the perioperative MPAP value 43 …”

Section: Discussionmentioning

confidence: 99%

Fontan procedure in patients with preoperative mean pulmonary artery pressure over 15 mmHg

et al. 2021

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Background Several factors affect the long‐term outcome of Fontan procedure, but a high pulmonary artery pressure is still one of the most important limitation for proceeding to a Fontan circulation. Herein, we present our experience in Fontan patients with high preoperative pulmonary artery pressures. Methods A retrospective analysis was performed to evaluate Fontan patients with a preoperative pulmonary artery pressure >15 mmHg between 2009 and 2020. Sixteen patients were operated on with a mean preoperative pulmonary artery pressure of 17.5 ± 2.1 mmHg. Results Mean age at the time of Fontan procedure was 7.8 ± 5.6 years. All the patients had stage 2 cavopulmonary anastomosis before Fontan completion, with a mean interstage period of 4 ± 2.6 years. Fontan completion was achieved with a polytetrafluorethylene tubular conduit, two of which were intra‐extracardiac. Fenestration was performed in five (31%) cases. Postoperative pulmonary artery pressures and arterial oxygen saturation levels were 11.2 ± 2.8 and 97.8 ± 2 mmHg, respectively. Mean duration of pleural drainage was 3.9 ± 5.3 days. Any morbidity and mortality were not encountered during a mean follow‐up period of 4.8 ± 7.7 years. Conclusions The midterm results of stage 3 Fontan completion in patients with pulmonary artery >15 mmHg are encouraging. Not only the mean pulmonary artery pressure but also the pulmonary vascular resistance may be helpful in order to identify the high risk patients before Fontan completion.

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“…Moreover, baffl e fenestration performed at the time of Fontan surgery improves short-term outcomes in standard-risk patients by decreasing pleural drainage, length of hospital stay, and need for additional postoperative procedure. 8,9 The closure of Fontan fenestration was not indicated. A persistent fenestration may be a benefi t, as lower central venous pressure may decrease the risk of exercise intolerance, protein losing enteropathy, plastic bronchitis and bradyarrhythmias.…”

Section: Discussionmentioning

confidence: 99%

A unique case of embolic myocardial infarction in a 22-year-old woman with Fontan circulation

Vachalcová¹,

Jakubova²,

Czerny³

et al. 2021

Cor Vasa

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Embólia koronárnych artérií je menej častou príčinou akútneho infarktu myokardu. Predstavujeme kazuistiku 22-ročnej pacientky s dvojvtokovou ľavou komorou, defektom komorového septa a pulmonálnou stenózou po Fontanovej operácii s akútnym spodným STEMI na embolickom podklade. Okrem známych rizík vedúcich k trombotickým komplikáciám spojeným s Fontanovskou cirkuláciou, medzi potenciálne predisponujúce faktory trombembolizmu u tejto pacientky patrili vytvorenie trombu v dolnej dutej žile a nedostatočná antikoagulačná liečba. Táto kazuistika predstavuje jednu z prvých dokumentovaných embolických príčin STEMI u pacienta s Fontanovskou cirkuláciou. Doteraz nie je vytvorený konsenzus, že antikoagulačná terapia warfarínom je u pacientov s Fontanovskou cirkuláciou superiórna voči aspirínu v primárnej prevencii trombembolických príhod.

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Comparison of the fenestrated and non-fenestrated Fontan procedures

Abstract: Supplemental Digital Content is available in the text

Cited by 21 publications

References 30 publications

Risk factors for prolonged ventilation after the modified Fontan procedure

Risk factors for prolonged ventilation after the modified Fontan procedure

Fontan procedure in patients with preoperative mean pulmonary artery pressure over 15 mmHg

A unique case of embolic myocardial infarction in a 22-year-old woman with Fontan circulation

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