Improved Technique for Interventional Extracardiac Fontan

Prabhu, Sudesh; Maiya, Shreesha; Shetty, Riyan; Murthy, Keshava; Ramachandra, Prakash; Karl, Tom R.

doi:10.1177/2150135120918541

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…The creation of an extracardiac Fontan was reported in humans using a similar approach in 2017 and 2020. Reports in the literature involve, however, small numbers of patients with limited follow-up intervals ( 78 , 79 ).…”

Section: Percutaneous Fontan Completionmentioning

confidence: 99%

Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments

et al. 2022

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The Fontan operation represents the last of multiple steps that are offered a wide range of congenital cardiac lesions with a single ventricle (SV) physiology. Nowadays this surgical program consists of a total cavopulmonary connection (TCPC), by anastomosing systemic veins to the pulmonary arteries (PAs), excluding the right-sided circulation from the heart. As a result of imaging, surgical, percutaneous, and critical care improvements, survival in this population has steadily increased. However, the Fontan physiology chronically increases systemic venous pressure causing systemic venous congestion and decreased cardiac output, exposing patients to the failure of the Fontan circulation (FC), which is associated with a wide variety of clinical complications such as liver disease, cyanosis, thromboembolism, protein-losing enteropathy (PLE), plastic bronchitis (PB), and renal dysfunction, ultimately resulting in an increased risk of exercise intolerance, arrhythmias, and premature death. The pathophysiology of the failing Fontan is complex and multifactorial; i.e., caused by the single ventricle dysfunction (diastolic/systolic failure, arrhythmias, AV valve regurgitation, etc.) or caused by the specific circulation (conduits, pulmonary vessels, etc.). The treatment is still challenging and may include multiple options and tools. Among the possible options, today, interventional catheterization is a reliable option, through which different procedures can target various failing elements of the FC. In this review, we aim to provide an overview of indications, techniques, and results of transcatheter options to treat cavopulmonary stenosis, collaterals, impaired lymphatic drainage, and the management of the fenestration, as well as to explore the recent advancements and clinical applications of transcatheter cavopulmonary connections, percutaneous valvular treatments, and to discuss the future perspectives of percutaneous therapies in the Fontan population.

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Section: Percutaneous Fontan Completionmentioning

confidence: 99%

Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments

et al. 2022

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“…In the 50 years following the introduction of the procedure named after Francis Fontan (1), the indications as well as the surgical techniques have substantially evolved. The Fontan operation, which may be performed with various surgical techniques, is the final stage of surgical palliation for functionally univentricular hearts (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). A surgically created fenestration (or connection) between the Fontan circuit and the atrial cavity to reduce excessively elevated systemic venous pressures and to improve cardiac output by increasing the filling of the single ventricle may be beneficial in the immediate postoperative period (21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis

Greenleaf

Lim

et al. 2022

Front. Pediatr.

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BackgroundMeta-analysis of the impact on clinical outcome from transcatheter closure of Fontan fenestration.MethodsCochrane, Embase, MEDLINE, and Open-Gray were searched. Parameters such as changes in oxygen saturation, cavo-pulmonary pressure, maximum heart rate during exercise, exercise duration, and oxygen saturation after fenestration closure were pooled and statistical analysis performed.ResultsAmong 922 publications, 12 retrospective observational studies were included. The included studies involved 610 patients, of which 552 patients (90.5%) had a fenestration. Of those patients, 505 patients (91.5%) underwent attempt at trans-catheter closure. When it could be estimated, the pooled overall mean age at trans-catheter fenestration closure was 6.6 ± 7.4 years, and the mean follow-up time was 34.4 ± 10.7 months. There were 32 minor (6.3%) and 20 major (4.0%) complications during or after trans-catheter Fontan fenestration closure. The forest plots demonstrate that following fenestration closure, there was a significant increase in the mean arterial oxygen saturation of 7.9% (95% CI 6.4–9.4%, p < 0.01). There was also a significant increase in the mean cavo-pulmonary pressure of 1.4 mmHg (95% CI 1.0–1.8 mmHg, p < 0.01) following fenestration closure. The exercise parameters reported in 3 studies also favored closing the fenestration as well, yet the exercise duration increase of 1.7 min (95% CI 0.7–2.8 min, p < 0.01) after fenestration closure is probably clinically insignificant.ConclusionLate closure of a Fontan fenestration has the impact of improving resting oxygen saturation, exercise oxygen saturation, and a modest improvement of exercise duration. These clinical benefits, however, may be at the expense of tolerating slightly higher cavo-pulmonary mean pressures.

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“…[12][13][14] In 2017 and 2022, Prabhu et al reported two cases using this technique where the surgical preconditioning was done in old children (5 and 11 years young). 15,16 We report here a very innovative approach for transcatheter extracardiac Fontan completion to allow preparation at an early age.…”

mentioning

confidence: 99%

Transcatheter Fontan completion: Creation of an extracardiac Fontan

Boudjemline,

Hijazi,

Sallehuddin

et al. 2024

Cathet Cardio Intervent

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Patients with functionally univentricular hearts are usually palliated surgically. There have been several reports of successful attempts to complete the Fontan procedure without surgery. The pathways created at the time of the preconditioning were largely reminiscent of the lateral tunnel Fontan. However, this approach is still confidentially limited to a small number of centers. In 2013, we designed a circuit that mimics the actual surgical technique of extracardiac total cavopulmonary connection to allow for transcatheter completion in an animal study. A polytetrafluoroethylene conduit was connected between the pulmonary artery and the inferior vena cava (IVC). The superior anastomosis was occluded to avoid flow between IVC and superior vena cava (SVC). The conduit was connected to the right atrium (RA) and a large fenestration was created to allow free flow from the IVC to the RA. Extrapolating our approach, a center reported the successful transcatheter completion of an extracardiac Fontan in a 6‐year‐old child. However, this technique is not directly transposable to our population of patients who require preconditioning in infancy. We report here an innovative extension of this technique that may allow preparing patients in infancy, ideally at the time of the Glenn in the future, to receive an extracardiac Fontan at 2 years/11 kg without additional surgery.

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Improved Technique for Interventional Extracardiac Fontan

Cited by 5 publications

References 14 publications

Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments

Transcatheter interventions in patients with a Fontan circulation: Current practice and future developments

Impact on clinical outcomes from transcatheter closure of the Fontan fenestration: A systematic review and meta-analysis

Transcatheter Fontan completion: Creation of an extracardiac Fontan

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