Transcatheter Ablation via a Sternotomy Approach as a Hybrid Procedure in a Univentricular Heart

Khairy, Paul; Fournier, A; Ruest, Pierre; Vobecky, Suzanne

doi:10.1111/j.1540-8159.2008.01058.x

Cited by 39 publications

(16 citation statements)

References 3 publications

(3 reference statements)

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“…24 A combined approach with cardiac surgery and interventional electrophysiology with the catheter ablation performed via an atriotomy incision was also reported, as well as transbaffle punctures across the extracardiac conduit. 21,22,25 Since these approaches carry a significant risk of major complication, it is very likely that RMN using retrograde aortic access offers major safety advantage over conventional approaches, although no comparative studies are available. In the small number of patients with TCPC for whom RMN was used, no major complication related to catheter navigation and ablation were observed, in contrast to the much more invasive approaches described above.…”

Section: Fontan Circulation and Tcpcmentioning

confidence: 99%

“…16,20 Different approaches have been proposed to overcome the challenges related to access to the arrhythmia circuits in specific anatomy/surgical repair situations. Some of the techniques reported are transbaffle puncture, [21][22][23] transthoracic percutaneous techniques, 24 as well as surgical and interventional electrophysiologic hybrid approaches, 25 with catheter ablation performed via an atriotomy incision. However, such approaches carry a significant perioperative risk and must be reserved for carefully selected cases.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

Roy

Gómez-Pulido

Ernst

2016

Cardiovasc electrophysiol

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Review on Remote Magnetic Navigation in Congenital Heart Disease. In patients with congenital heart disease, challenges to catheter-based arrhythmia interventions are unique and numerous given the complexity of the underlying defects, anatomic and surgical intervention variants including baffles, conduits, patches, and/or shunts. Remote magnetic navigation offers significant advantages in these cases that may present with limited vascular access or difficult access to the target cardiac chambers implicated by the previous surgical interventions. We reviewed the data available on the safety, feasibility, and effectiveness of magnetic navigation for the treatment of arrhythmia in congenital heart disease and discussed the specific challenges related to various congenital defects and repair with the potential advantages offered by magnetic navigation in these

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Section: Fontan Circulation and Tcpcmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

Roy

Gómez-Pulido

Ernst

2016

Cardiovasc electrophysiol

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show abstract

“…Khairy et al 21 report "Transcatheter ablation via a sternotomy approach as a hybrid procedure in a univentricular heart." In this case report, the authors describe a 6-year-old girl who developed unstable supraventricular tachycardia shortly after her Fontan operation.…”

Section: Advantage 4: Atrial Access For Electrophysiology Study May Smentioning

confidence: 99%

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

Kogon

2012

Circulation

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W ith improvements in technology, operative technique, and critical care medicine, more and more children with congenital heart disease are surviving into adulthood. As they age, these patients are providing physicians with new challenges, and we are realizing the long-term consequences of our previous interventions. This oftentimes has changed the mode of treatment for subsequent children. Response by Khairy and Poirier on p 2515Fontan palliation for single-ventricle patients was first described in 1971. 1 The original approach was in the form of a classic atriopulmonary Fontan connection, bypassing the nonfunctional right ventricle. After recognizing the long-term complication of an atriopulmonary connection (right atrial dilation, arrhythmias, and thrombus formation), modifications have been made. The atriopulmonary connection has been abandoned in favor of modified Fontan anatomy and physiology.The modified Fontan can be performed by the use of an extracardiac conduit approach or a lateral tunnel approach. The extracardiac Fontan uses an external conduit to anastomose the inferior vena cava into the pulmonary arteries, whereas a lateral tunnel Fontan uses a baffle within the right atrium (Figure 1). Because the systemic venous pathway is completely separated from the right atrium with the extracardiac Fontan, it is more challenging for the electrophysiologist to access the heart for ablation. My aim is to demonstrate why "the extracardiac conduit is the preferred Fontan approach for patients with univentricular hearts."The extracardiac Fontan has several advantages over the lateral tunnel Fontan. Advantage 1: Reduced Cardiopulmonary Bypass and Ischemic TimesMinimizing cardiopulmonary bypass and ischemia may optimize early postoperative outcomes. In multiple studies, both prolonged cardioplegic arrest and extended cardiopulmonary bypass times have been associated with an increased risk of early postoperative death or Fontan failure. [2][3][4] The technique of Fontan construction often dictates whether cardiopulmonary bypass or a period of ischemic arrest are required. With the lateral tunnel Fontan, the right atrium is opened for creation of the inferior vena cava baffle, necessitating the use of cardiopulmonary bypass. In addition, a period of cardioplegic arrest is required to stop the heart to prevent air embolic events until the atrium is closed. With the extracardiac Fontan, the right atrium is not opened. Vascular control is achieved at the right atrial-inferior vena cava junction. The inferior vena cava is transected and sewn to the extracardiac conduit, and the cardiac opening is oversewn. Vascular control of the pulmonary arteries is then achieved, and the conduit is sewn to the right pulmonary artery. Last, side-biting clamps are placed on the right atrium and conduit to create a fenestration if desired. With the use of this

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“…73 We performed a hybrid intervention in a hemodynamically unstable child with atrial arrhythmias in the acute postoperative setting after completion of an extracardiac conduit ( Figure 5). 74 The thorax was reopened, and, through a small atriotomy incision, the ablation catheter was advanced in the pulmonary venous atrium. Such an approach appears best reserved for dire circumstances.…”

Section: Managing Arrhythmias With the Standard Extracardiac Fontanmentioning

confidence: 99%

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

Khairy

Poirier

2012

Circulation

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Transcatheter Ablation via a Sternotomy Approach as a Hybrid Procedure in a Univentricular Heart

Cited by 39 publications

References 3 publications

Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

Remote Magnetic Navigation for Catheter Ablation in Patients With Congenital Heart Disease: A Review

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

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

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