Intra-Extracardiac Versus Extracardiac Fontan Modifications: Comparison of Early Outcomes

Sinha, Lok; Öztürk, Mahmut; Zurakowski, David; Yerebakan, Can; Ramakrishnan, Karthik; Matisoff, Andrew; Ruth, J. F. Loos; Jonas, Richard A.; Sinha, Pranava

doi:10.1016/j.athoracsur.2018.07.080

Cited by 13 publications

(7 citation statements)

References 13 publications

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“…It was thought that early extubation was associated with shorter drainage time and hospital stay (12). There were also articles reporting that IEC Fontan procedure was related with shorter drainage period than the EC Fontan procedure (13). In our study, absence of a standardized treatment protocol wasdetermined as a risk factor for prolonged drainage.…”

Section: Commentmentioning

confidence: 51%

Parameters affecting pleural drainage and a management strategy after Fontan operation

n¹,

Yıldız²,

Ayyıldız

et al. 2020

Preprint

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Background: Prolonged pleural drainage after the Fontan procedure is a common complication. Various protocols have been described, but there is no definitive consensus for the treatment of this complication. Materials and Methods: Our primary aim was to determine the effect of the protocol on the duration of drainage and hospital stay. Our secondary aim was to determine parameters affecting prolonged drainage after the Fontan procedure. Ninety two consecutive patients who underwent the Fontan operation retrospectively analyzed. A protocol-based postoperative management was adopted at July 2018. Patients operated before the protocol were defined as Group 1(n=48), and patients operated after the protocol were defined as Group 2(n=44). Results: The mean age was 5(IQR 4.0-6.9) years the mean body weight was 17.3 (IQR 15.1-21.8) kg.There were statistically significant differences between groups in terms of total drainage, duration of pleural drainage, prolonged drainage and, LOHS(p=0.05,p=0.04, p=0.04,p=0.04,respectively). In the multivariate analysis, the application of the protocol was observed to be the only factor for prolonged drainage (OR:2.46, 95% CI Lower-Upper:1.03-5.86,p=0.04). Conclusion: Standardization and strict application of the medical treatment within a specific protocol without being affected by doctor, nurse or patientbased factors increases the success. After the changes in our medical management strategy, along with the decrease in total drainage and duration of pleural drainage, LOHS was also reduced, of course together with a reduction in the cost.

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Section: Commentmentioning

confidence: 51%

Parameters affecting pleural drainage and a management strategy after Fontan operation

n¹,

Yıldız²,

Ayyıldız

et al. 2020

Preprint

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“…14 It has also been reported that the drainage period was shorter for the IEC Fontan procedure than the EC Fontan procedure. 15 In our study, the absence of a standardized treatment protocol was determined as a risk factor for prolonged drainage.…”

Section: Discussionmentioning

confidence: 95%

Parameters affecting pleural drainage and management strategy after Fontan operation

et al. 2020

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Background Prolonged pleural drainage is a common complication after undergoing the Fontan procedure. Although various protocols have been described, there is no definitive consensus for how to treat this complication. Materials and Methods Our primary aim was to determine the effect of the management strategy protocol on the duration of drainage and length of hospital stay. Our secondary aim was to determine the parameters affecting the need for prolonged drainage after the Fontan procedure. Ninety‐two consecutive patients who underwent the Fontan procedure were retrospectively analyzed. A protocol‐based postoperative management strategy was adopted in July 2018. Group 1 (n = 48) consisted of patients that underwent the procedure before the protocol was implemented. Group 2 (n = 44) consisted of patients that underwent the procedure after the protocol was implemented. Results The mean age was 5 years (interquartile range [IQR], 4.0‐6.9); the mean body weight was 17.3 kg (IQR, 15.1‐21.8). Statistically significant differences were found between the groups in terms of total drainage, duration of pleural drainage, prolonged drainage, and length of hospital stays (LOHS) (P = .05, P = .04, P = .04, P = .04, respectively). The multivariate analysis results showed that the application of the protocol was the only factor impacting prolonged drainage (OR, 2.46, 95% CI lower‐upper: 1.03‐5.86, P = .04). Conclusion Standardization and strict application of the medical treatment within a specific protocol without being affected by doctor‐, nurse‐, or patient‐based factors increases the success rate of this procedure. After implementing the changes in the medical management strategy, total drainage and duration of pleural drainage and LOHS decreased, and the costs associated with these factors also decreased.

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“…In the era of LT and ECF, the spontaneous closure of surgically created fenestrations could be as high as 19% ( 14). Sinha et al reported that only 66% of fenestrations were patent at the time of discharge in ECF patients, whereas this ratio was 95% in IECF patients (22). In a catheter-based analysis in 35 patients, Hirofumi and colleagues reported that persistent fenestration in Fontan circulation suppresses heart rate and CVP, which secures preload reserve without compromising systemic oxygen delivery (23).…”

Section: Discussionmentioning

confidence: 99%

Mid Term Results of Fenestrated Intra-Extracardiac Fontan Procedure: Insights, Experiences and Expectations

Özyüksel¹,

Şimşek²,

Demiroluk³

et al. 2021

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Background: Intraextracardiac Fontan procedure aimed to combine the advantages of lateral tunnel and extracardiac conduit modifications of the original technique. Herein, we present our experience in our patients with intraextracardiac fenestrated Fontan Procedure. Methods: A retrospective analysis was performed in order to evaluate intraextracardiac fenestrated Fontan patients between 2014 and 2021. Seventeen patients were operated on with a mean age and body weight of 9.1 ± 5.5 years and 28.6 ± 14.6 kg. Results: Sixteen patients (94%) were palliated as univentricular physiology with hypoplasia of one of the ventricles. One patient (6%) with well-developed two ventricles with double outlet right ventricle and complete atrioventricular septal defect had straddling of the chordae prohibiting a biventricular repair. All of the patients had cavopulmonary anastomosis prior to Fontan completion, except one case. Fenestration was performed in all cases. Postoperative mean pulmonary artery pressures and arterial oxygen saturation levels at follow up were 10 ± 2.4 mmHg and 91.3 ± 2.7 %, respectively. Mean duration of pleural drainage was 5.4 ± 2.3 days. All of the fenestrations are patent at a mean follow up period of 4.8 ± 7.7 years, except one case. Any morbidity and mortality were not encountered. Conclusions: The mid-term results of intraextracardiac fenestrated Fontan procedure are encouraging. This procedure may improve the results in a patient population who should be palliated as univentricular physiology, especially in cases with complex cardiac anatomy.

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Intra-Extracardiac Versus Extracardiac Fontan Modifications: Comparison of Early Outcomes

Cited by 13 publications

References 13 publications

Parameters affecting pleural drainage and a management strategy after Fontan operation

Parameters affecting pleural drainage and a management strategy after Fontan operation

Parameters affecting pleural drainage and management strategy after Fontan operation

Mid Term Results of Fenestrated Intra-Extracardiac Fontan Procedure: Insights, Experiences and Expectations

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