Fontan Operation: A Comparison of Lateral Tunnel with Extracardiac Conduit

Is the Extracardiac Conduit the Preferred Fontan Approach for Patients With Univentricular Hearts?

“…35,40 For example, in a study of 162 patients of whom 113 had lateral tunnels and 49 had extracardiac conduits, time on the extracorporeal circuit was similar between the 2 groups (107Ϯ42 minutes for the lateral tunnel versus 117Ϯ41 minutes for the extracardiac conduit). 24 Nevertheless, the extracardiac conduit was associated with a significantly longer hospital stay (mean of 25 versus 13 days) and trend toward longer ventilatory support (20.1 versus 8.4 hours). 24 Additional disadvantages of the extracardiac Fontan include the potential for tunnel stenosis requiring stenting or surgical revision, 41,42 a higher rate of healthcare resource use, 24 and the lack of growth potential of the synthetic tube.…”

“…24 Nevertheless, the extracardiac conduit was associated with a significantly longer hospital stay (mean of 25 versus 13 days) and trend toward longer ventilatory support (20.1 versus 8.4 hours). 24 Additional disadvantages of the extracardiac Fontan include the potential for tunnel stenosis requiring stenting or surgical revision, 41,42 a higher rate of healthcare resource use, 24 and the lack of growth potential of the synthetic tube. The latter limitation has prompted some to suggest that it is less suitable in young children, particularly those Ͻ3 years of age.…”

“…Studies have consistently shown that postoperative Fontan pressures and transpulmonary gradients are similar with the 2 types of total cavopulmonary connections and that identical functional parameters are obtained on follow-up. 21,24,25 …”

“…Not surprisingly, cohort studies comparing intracardiac lateral tunnel with extracardiac Fontans have reported similar operative morbidity and mortality and midterm survival ( Figure 2B). [21][22][23][24][25][26] Thus, in contrast to anatomic considerations such as ventricular morphology and function, 14 total anomalous pulmonary venous return, 27,28 and heterotaxy syndromes, 27,29 the type of Fontan surgery has not convincingly been associated with long-term survival.…”

Hemodynamic Changes and Clinical Outcomes after the Intra/Extracardiac Fenestrated Fontan Procedure

“…However, a decrease in fenestration usage has ultimately lead to an increased duration of pleural effusions (10 days ± 12 days with fenestration, 13.2 days ± 8.8 days without fenestration) [8]. In addition, while the purpose of the Extracardiac conduit was to lower the incidence of arrhythmias, many studies have shown the incidence of post-operative arrhythmias to be comparable to the Lateral Tunnel [9] [10]. Some studies have also shown an association between the use of the Extracardiac conduit and a higher incidence of sinus node dysfunction [11].…”