Pediatric Cardiology

, Volume 33, Issue 7, pp 1078–1085

Early Outcomes After Extracardiac Conduit Fontan Operation Without Cardiopulmonary Bypass

  • Amy N. McCammond
  • Kevin Kuo
  • Victoria N. Parikh
  • Kameelah Abdullah
  • Raymond Balise
  • Frank L. Hanley
  • Stephen J. Roth
Original Article

DOI: 10.1007/s00246-012-0228-5

Cite this article as:
McCammond, A.N., Kuo, K., Parikh, V.N. et al. Pediatr Cardiol (2012) 33: 1078. doi:10.1007/s00246-012-0228-5


Cardiopulmonary bypass is associated with a systemic inflammatory response. The authors hypothesized that avoiding cardiopulmonary bypass would lead to improved postoperative outcomes for patients undergoing the extracardiac Fontan operation, the final stage in surgical palliation of univentricular congenital heart defects. A review of the Children’s Heart Center Database showed a total of 73 patients who underwent an initial Fontan operation at Lucile Packard Children’s Hospital at Stanford between 1 November 2001 and 1 November 2006. These patients were divided into two groups: those who underwent cardiopulmonary bypass (n = 26) and those who avoided cardiopulmonary bypass (n = 47). Preoperative demographics, hemodynamics, and early postoperative outcomes were analyzed. The two groups had comparable preoperative demographic characteristics and hemodynamics except that the average weight of the off-bypass group was greater (17.9 ± 9.1 vs 14.2 ± 2.7 kg; P = 0.01). Intraoperatively, the off-bypass group trended toward a lower rate of Fontan fenestration (4.3 vs 19.2%; P = 0.09), had lower common atrial pressures (4.6 ± 1.4 vs 5.5 ± 1.5 mmHg; P = 0.05), and Fontan pressures (11.9 ± 2.1 vs 14.2 ± 2.4 mmHg; P ≤ 0.01), and required less blood product (59.1 ± 37.6 vs 91.9 ± 49.4 ml/kg; P ≤ 0.01). Postoperatively, there were no significant differences in hemodynamic parameters, postoperative colloid requirements, duration of mechanical ventilation, volume or duration of pleural drainage, or duration of cardiovascular intensive care unit or hospital stay. Avoiding cardiopulmonary bypass influenced intraoperative hemodynamics and the incidence of fenestration but did not have a significant impact on the early postoperative outcomes of children undergoing the Fontan procedure.


Cardiopulmonary bypassCHD–FontanComplications and managementCPBInflammatory responseOff-pump surgeryOutcomes





Common atrial pressure


Cardiopulmonary bypass


Cardiovascular intensive care unit


Double inlet left ventricle


Extracardiac conduit


Extracorporeal mechanical oxygenation


Fresh frozen plasma


Hypoplastic left heart syndrome


Pulmonary atresia with intact ventricular septum


Packed red blood cells


Pulmonary vascular resistance


Supraventricular tachycardia


Transpulmonary gradient

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Amy N. McCammond
    • 1
  • Kevin Kuo
    • 2
  • Victoria N. Parikh
    • 2
  • Kameelah Abdullah
    • 3
  • Raymond Balise
    • 3
  • Frank L. Hanley
    • 4
  • Stephen J. Roth
    • 2
  1. 1.Department of PediatricsDoernbecher Children’s Hospital, Oregon Health & Science UniversityPortlandUSA
  2. 2.Department of PediatricsLucile Packard Children’s Hospital at Stanford, Stanford University School of MedicinePalo AltoUSA
  3. 3.Department of Health Research and PolicyLucile Packard Children’s Hospital at Stanford, Stanford University School of MedicinePalo AltoUSA
  4. 4.Department of Cardiothoracic SurgeryLucile Packard Children’s Hospital at Stanford, Stanford University School of MedicinePalo AltoUSA