The Fontan-operation: from intra- to extracardiac procedure

Kuroczynski, W.; Kampmann, Christoph; Choi, Yeong‐Hoon; Pruefer, Diethard; Singelmann, Joachim; Huth, R.; Schmid, Franz X.; Heinemann, Markus K.; Oelert, H.

doi:10.1016/s0967-2109(02)00142-4

Cited by 8 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Operative mortality of the FP has steadily decreased and in the best centers is no higher than for many biventricular repairs [18, 19]. This improvement over the past decade is a result of a number of factors, including better patient selection and improved surgical technique [4, 10, 12, 14, 16]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intra- or extracardiac Fontan operation? A simple strategy when to do what

Kuroczynski¹,

Senft²,

Elsaesser³

et al. 2014

aoms

View full text Add to dashboard Cite

IntroductionThe complete Fontan circulation is the definite palliation for many complex congenital cardiac lesions. After bi-directional Glenn anastomosis (BDG), two well-established techniques – intracardiac tunneling and extracardiac prosthesis – are available for completion, although the choice of technique is still a matter of debate.Material and methodsWe retrospectively reviewed the surgical and clinical records of patients with single ventricle physiology, who underwent intracardiac (group I) or extracardiac (group II) Fontan palliation after BDG.ResultsComplete data were available in 72 patients. Thirty-eight patients received intracardiac (median weight: 12.6 kg) and 34 patients extracardiac repair (median weight: 15.6 kg). Patients with intracardiac tunneling had longer cardiopulmonary bypass (CBP) time (170 min vs. 104 min; p < 0.001), longer ventilatory (39 h vs. 21 h; p = 0.009) and longer inotropic support (48 h vs. 10 h; p < 0.001). Ventilatory and inotropic support were dependent on CPB (r = 0.69 and r = 0.637) and on aortic cross-clamping (r = 0.785 and r = 0.705 only group I), but not dependent on age, weight or pulmonary artery pressure (PAP).ConclusionsBoth techniques are feasible without perioperative mortality. Normally developed children with good hemodynamics after BDG received an elective extracardiac procedure without fenestration later. Patients with developmental retardation, severe progressive cyanosis, myocardial dysfunction, or moderate to severe atrio-ventricular valve insufficiency are scheduled for an earlier intracardiac baffle repair with routine fenestration, as they are at higher risk. Prolonged CPB and aortic cross-clamping times adversely impact the early postoperative course. Further strategies must be developed to avoid these effects, particularly in the patient group at higher imminent risk.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Many of the early postoperative problems can result from perioperative factors such as the CPB and/or aortic cross-clamping and cardioplegic arrest times [14]. Despite widespread acceptance of the FP for the treatment of functional single ventricle, significant controversy remains over the optimal operative strategy [11, 19].…”

Section: Discussionmentioning

confidence: 99%

Intra- or extracardiac Fontan operation? A simple strategy when to do what

Kuroczynski¹,

Senft²,

Elsaesser³

et al. 2014

aoms

View full text Add to dashboard Cite

show abstract

“…Um die Flussdynamik in einem derart für die Fontan-Zirkulation angelegten intrakardialen Tunnel zu optimieren und dadurch das potentielle Risiko einer systemischen venösen Hypertonie sowie von Arrhythmien im Langzeitverlauf zu verringern, griffen einige kardiochirurgische Zentren sehr bald eine weitere Modifikation der Fontan-Operation auf, nämlich die der extrakardialen Variante mit bidirektionaler Glenn-Anastomose meist ohne Fenestration [2,3,5,30,43,63].…”

Section: Postoperative Problematik -Eiweißverlust-syndromunclassified

“…Hierzu gehören Lungenvenen-und Systemvenenfehlmündungen sowie eine Kombination von beiden. Inzwischen favorisiert eine wachsende Zahl von Herzchirurgen diese extrakardiale Variante der Fontan-Operation bei Patienten mit jeglicher Art der Single-Ventricle-Physiologie [2,5,43,51,71].…”

Section: Die Totale Kavopulmonale Anastomoseextrakardiale Varianteunclassified

“…Zusammenfassend wird heutzutage als erster Schritt der Fontan-Prozedur eine bidirektionale kavopulmonale Anastomose angelegt, und als zweiter Schritt erfolgt die Konstruktion eines lateralen intrakardialen Tunnels oder, zunehmend mehr bevorzugt, die Implantation eines extrakardialen Conduits unter Verzicht auf die Fenestration mit Hilfe der Herz-Lungen-Maschine am schlagenden Herzen, meist in Normothermie [2,3,5,7,43,51,63,77]. gerung des Katecholaminbedarfs einen negativen Effekt auf den venösen Blutrückstrom in der Fontan-Zirkulation.…”

Section: Die Totale Kavopulmonale Anastomoseextrakardiale Varianteunclassified

See 1 more Smart Citation

Entwicklung der Fontan-Prozedur als Behandlungskonzept für Kinder mit angeborenen komplexen Herzfehlern

Kuroczynski

2007

Herz

View full text Add to dashboard Cite

The spectrum of congenital heart defects reaches from very simple to extremely complex anomalies. 3 decades earlier, the prognosis of children with univentricular heart defects was poor. The Fontan procedure has been offered to patients with a variety of complex cyanotic heart diseases and has resulted in decreased mortality. This review summarizes the development and modifications of the Fontan procedure. The advances in preoperative, intraoperative und postoperative patient management have resulted in greatly improved survivals for even the most complex congenital defects. Over the past 3 decades, the survival of infants with critical congenital heart defects has increased to 90%.

show abstract

“Single Ventricle” Repairs

Hoffman

2009

The Natural and Unnatural History of Congenital Heart Disease

View full text Add to dashboard Cite

The Fontan-operation: from intra- to extracardiac procedure

Cited by 8 publications

References 23 publications

Intra- or extracardiac Fontan operation? A simple strategy when to do what

Intra- or extracardiac Fontan operation? A simple strategy when to do what

Entwicklung der Fontan-Prozedur als Behandlungskonzept für Kinder mit angeborenen komplexen Herzfehlern

“Single Ventricle” Repairs

Contact Info

Product

Resources

About