Pediatric Cardiology

, Volume 33, Issue 7, pp 1078–1085

Early Outcomes After Extracardiac Conduit Fontan Operation Without Cardiopulmonary Bypass

Authors

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

Abstract

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.

Keywords

Cardiopulmonary bypassCHD–FontanComplications and managementCPBInflammatory responseOff-pump surgeryOutcomes

Abbreviations

AV

Atrioventricular

CAP

Common atrial pressure

CPB

Cardiopulmonary bypass

CVICU

Cardiovascular intensive care unit

DILV

Double inlet left ventricle

ECC

Extracardiac conduit

ECMO

Extracorporeal mechanical oxygenation

FFP

Fresh frozen plasma

HLHS

Hypoplastic left heart syndrome

PA/IVS

Pulmonary atresia with intact ventricular septum

PRBC

Packed red blood cells

PVR

Pulmonary vascular resistance

SVT

Supraventricular tachycardia

TPG

Transpulmonary gradient

Copyright information

© Springer Science+Business Media, LLC 2012