Extracardiac total cavopulmonary connection using a Y-shaped graft

Preliminary clinical experience with a bifurcated Y-graft Fontan procedure—A feasibility study

“…We chose to perform all the operations with cardiopulmonary bypass (CPB) and cardioplegic arrest. Undoubtedly, this procedure can be performed safely without CPB with or without venous shunting as suggested previously(10;14). Also, because of ease and reliability of creating a fenestration, we chose to employ elements of the intra/extracardiac Fontan procedure(11) rather than constructing a completely extracardiac Fontan connection.…”

“…Okano from Kyoto, Japan, described the use of a 22×11×11 mm Dacron Y-graft in a 17 year-old with previous bilateral bidirectional Glenn anastomoses who developed severely distorted hypoplastic central pulmonary arteries between the two superior cavopulmonary anastomoses(10). In that case, the two 11 mm limbs of the Y-graft were anastomosed separately to the RPA and the LPA with the LPA limb being brought in a non-anatomic position anterior to the ascending aorta.…”

“…No attemp t was made to avoid cardiopulmonary bypass using temporary venous bypass as described by Okano and colleagues(10). After cardioplegic arrest, the right atrium was opened through a short lateral incision.…”

Constrained optimization of an idealized Y-shaped baffle for the Fontan surgery at rest and exercise

“…As early as 2002, Okano et al [23] first performed an extracardiac Fontan procedure on a patient with a severely distorted central PA using a unique Y-shaped graft. Recently a similar Y-graft design was proposed and tested via simulation by two groups.…”

Cardiovascular Modeling

“…The complex Fontan surgery has evolved over the years, as the surgeons were gaining experience. Recently, an extracardiac Fontan was performed using a Y-shaped graft (Okano et al 2002). Following this, Marsden et al investigated the performance of the Y-graft design and variations of the design by making use of a patient-specific approach based on reconstructions from MR data (Marsden et al 2009).…”