Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Volume 14, Issue 1 , Pages 4-10 , 2011

Extracardiac Versus Intra-Atrial Lateral Tunnel Fontan: Extracardiac is Better

Presented at the American Association for Thoracic Surgery 90th Annual Meeting, May 1-5, 2010, Toronto, Ontario, Canada.

  • Carl Lewis Backer

      Affiliations

    • Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
    • Corresponding Author InformationAddress correspondence to Carl L. Backer, MD, Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, 2300 Children's Plaza, mc 22, Chicago, IL 60614
    • ,
  • Barbara J. Deal

      Affiliations

    • Division of Cardiology, Children's Memorial Hospital, and the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Sunjay Kaushal

      Affiliations

    • Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Hyde M. Russell

      Affiliations

    • Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Sabrina Tsao

      Affiliations

    • Division of Cardiology, Children's Memorial Hospital, and the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
    • ,
  • Constantine Mavroudis

      Affiliations

    • Division of Pediatric and Congenital Heart Surgery, Cleveland Clinic Foundation, Cleveland, OH

References 

  1. Puga FJ, Chiavarelli M, Hagler DJ. Modifications of the Fontan operation applicable to patients with left atrioventricular valve atresia or single atrioventricular valve. Circulation. 1987;76:II53–II60
  2. de Leval MR, Kilner P, Gewillig M, et al. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations (Experimental studies and early clinical experience). J Thorac Cardiovasc Surg. 1988;96:682–695
  3. Humes RA, Feldt RH, Porter CJ, et al. The modified Fontan operation for asplenia and polysplenia syndromes. J Thorac Cardiovasc Surg. 1988;96:212–218
  4. Marcelletti C, Corno A, Giannico S, et al. Inferior vena cava-pulmonary artery extracardiac conduit (A new form of right heart bypass). J Thorac Cardiovasc Surg. 1990;100:228–232
  5. Mavroudis C, Backer CL, Deal BJ, et al. Total cavopulmonary conversion and maze procedure for patients with failure of the Fontan operation. J Thorac Cardiovasc Surg. 2001;122:863–871
  6. Norwood WI, Jacobs ML. Fontan's procedure in two stages. Am J Surg. 1993;166:548–551
  7. Hsia TY, Migliavacca F, Pittaccio S, et al. Computational fluid dynamic study of flow optimization in realistic models of the total cavopulmonary connections. J Surg Res. 2004;116:305–313
  8. Lardo AC, Webber SA, Friehs I, et al. Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections. J Thorac Cardiovasc Surg. 1999;117:697–704
  9. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971;26:240–248
  10. Nürnberg JH, Ovroutski S, Alexi-Meskishvili V, et al. New onset arrhythmias after the extracardiac conduit Fontan operation compared with the intra-atrial lateral tunnel procedure: early and midterm results. Ann Thorac Surg. 2004;78:1979–1988
  11. Azakie A, McCrindle BW, Van Arsdell G, et al. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg. 2001;122:1219–1228
  12. Robbers-Visser D, Miedema M, Nijveld A, et al. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg. 2010;37:934–941
  13. Brown JW, Ruzmetov M, Deschner BW, et al. Lateral tunnel Fontan in the current era: is it still a good option?. Ann Thorac Surg. 2010;89:556–563
  14. Jacobs ML, Pelletier GJ, Pourmoghadam KK, et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg. 2008;33:626–632
  15. Lee JR, Kwak J, Kim KC, et al. Comparison of lateral tunnel and extracardiac conduit Fontan procedure. Interact Cardiovasc Thorac Surg. 2007;6:328–330
  16. Nakano T, Kado H, Ishikawa S, et al. Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method. J Thorac Cardiovasc Surg. 2004;127:730–737
  17. Stamm C, Friehs I, Mayer JE, et al. Long-term results of the lateral tunnel Fontan operation. J Thorac Cardiovasc Surg. 2001;121:28–41
  18. Harada Y, Uchita S, Sakamoto T, et al. Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?. Interact Cardiovasc Thorac Surg. 2009;9:50–54
  19. Nakano T, Kado H, Tachibana T, et al. Excellent midterm outcome of extracardiac conduit total cavopulmonary connection: results of 126 cases. Ann Thorac Surg. 2007;84:1619–1625
  20. Petrossian E, Reddy VM, Collins KK, et al. The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J Thorac Cardiovasc Surg. 2006;132:1054–1063
  21. Mahnke CB, Boyle GJ, Janosky JE, et al. Anticoagulation and incidence of late cerebrovascular accidents following the Fontan procedure. Pediatr Cardiol. 2005;26:56–61
  22. Jonas RA. Indications and timing for the bidirectional Glenn shunt versus the fenestrated Fontan circulation. J Thorac Cardiovasc Surg. 1994;108:522–524
  23. Iwaki H, Masuda M, Shiokawa Y, et al. The somatic growth of autologous vessels in venous pathway after extracardiac total cavopulmonary connection. J Card Surg. 2008;23:454–458
  24. Itatani K, Miyaji K, Tomoyasu T, et al. Optimal conduit size of the extracardiac Fontan operation based on energy loss and flow stagnation. Ann Thorac Surg. 2009;88:565–573

 Dr Backer reports receiving fees from Synthe Med. Dr Deal reports receiving fees from Medtronic.

PII: S1092-9126(11)00020-2

doi: 10.1053/j.pcsu.2011.01.019

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Volume 14, Issue 1 , Pages 4-10 , 2011

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