Lateral Tunnel Fontan in the Current Era: Is It Still a Good Option?

Brown, John W.; Ruzmetov, Mark; Deschner, Benjamin W.; Rodefeld, Mark D.; Turrentine, Mark W.

doi:10.1016/j.athoracsur.2009.10.050

Cited by 54 publications

(27 citation statements)

References 23 publications

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“…The current long-term results using the modern surgical alternatives are excellent (31, 32, 50–52). The challenge is to reproduce this outcome for the vast majority of patients, and to develop viable alternatives to deal with late failure.…”

Section: Resultsmentioning

confidence: 99%

“…In spite of chronically limited cardiac output (30), the Fontan Kreutzer procedure has improved significantly (31, 32) the prognosis and quality of life. However, to live with only one ventricle has some limitations as a consequence of high venous pressure in the limit of the peripheral edema and limited cardiac output.…”

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

“…The FK palliation represents without any doubt, the best surgical approach that we could offer today for these lesions. With the modern techniques, the late quality of life is remarkable, with almost 75% of survivors in NYHA class 1, in addition to an exercise tolerance of more than 60% of predicted value (31, 32). …”

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

“…The reality is that these problems occur as patients do live to late follow up. Under the best circumstances using the modern surgical techniques, at least 80% of patients with single ventricle are alive after 20 years, following at least three cardiac procedures (32). …”

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

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Reflections on Five Decades of the Fontan Kreutzer Procedure

Kreutzer

2013

Front. Pediatr.

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The first successful total right heart bypass via atriopulmonary anastomosis (APA) were reported in 1971 for patients with tricuspid atresia. At the Children’s Hospital of Buenos Aires, the cohort of such procedures started in July, when the first fenestrated right heart by pass was performed, with the interposition of a homograft between the right atrial appendage and the main pulmonary artery. In the second patient, instead of placing a homograft, the APA was achieved with the patient’s own pulmonary root harvested from the outflow tract of the right ventricle. These techniques were soon replaced in 1978 with the development of the direct valveless posterior APA. Since the very beginning the principle was that the right atrium only functions as a pathway rather than a pump (reason why no inferior vena cava valves were ever used), and the diastolic properties of the systemic ventricle regulate the only real “pump” of this system. The late hemodynamic problems inherent of the APA diminished with modern surgical techniques like the lateral tunnel (LT) or the extracardiac conduit (EC). In spite of the improvement in prognosis and quality of life that the modern techniques have brought for univentricular hearts (UH), with the passing of time, deterioration of this system is frequently seen, due to chronic low cardiac output, elevated central venous pressure making heart transplantation the final stage of treatment. Progressive increase in pulmonary vascular resistances and ventricular dysfunction result in a decline in quality of life and survival. However, the timing of this occurrence is variable, and many survivors enjoy today a satisfactory clinical status. The challenge is to develop a better solution for UH, but in the mean time the Fontan Kreutzer palliation represents the best and only surgical option. It is undoubtedly one of the triumphs of cardiac surgery in congenital heart disease.

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Section: Resultsmentioning

confidence: 99%

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

Section: Evolution Of the Suboptimal Fontan Kreutzer Hemodynamic Systemmentioning

confidence: 99%

See 2 more Smart Citations

Reflections on Five Decades of the Fontan Kreutzer Procedure

Kreutzer

2013

Front. Pediatr.

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“…[1][2][3][4][5] In the LT operation, one wall of the tunnel is native right atrium (RA), whereas, the remainder of the circumference is composed of a baffle that is sewn within the atrium. 6,7 Theoretically, the inclusion of native RA tissue permits the tunnel to grow with the patient, a factor that is invoked as one of the rationales for performing the LT procedure rather than Fontan modifications that use circumferential synthetic conduits.…”

mentioning

confidence: 99%