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

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 bypass CHD–Fontan Complications and management CPB Inflammatory response Off-pump surgery Outcomes 

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

References

  1. 1.
    Fontan F, Baudet E (1971) Surgical repair of tricuspid atresia. Thorax 26:240–248PubMedCrossRefGoogle Scholar
  2. 2.
    Petrossian E, Reddy VM, McElhinney DB et al (1999) Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg 117:688–696PubMedCrossRefGoogle Scholar
  3. 3.
    Marcelletti CF, Iorio FS, Abella RF (1999) Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2:131–142PubMedGoogle Scholar
  4. 4.
    McElhinney DB, Petrossian E, Reddy VM, Hanley FL (1998) Extracardiac conduit Fontan procedure without cardiopulmonary bypass. Ann Thorac Surg 66:1826–1828PubMedCrossRefGoogle Scholar
  5. 5.
    Petrossian E, Reddy VM, Collins KK et al (2006) The extracardiac conduit Fontan operation using minimal approach extracorporeal circulation: early and midterm outcomes. J Thorac Cardiovasc Surg 132:1054–1063PubMedCrossRefGoogle Scholar
  6. 6.
    Uemura H, Yagihara T, Yamashita K, Ishizaka T, Yoshizumi K, Kawahira Y (1998) Establishment of total cavopulmonary connection without use of cardiopulmonary bypass. Eur J Cardiothorac Surg 13:504–508PubMedCrossRefGoogle Scholar
  7. 7.
    Shikata F, Yagihara T, Kagisaki K et al (2008) Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions? Eur J Cardiothorac Surg 34:570–575PubMedCrossRefGoogle Scholar
  8. 8.
    Xu JP, Luo XJ, Chu JM, Li SJ, Liu YL (2005) Total cavopulmonary connection with off-pump technique. Asian Cardiovasc Thorac Ann 13:225–228PubMedGoogle Scholar
  9. 9.
    Navabi MA, Rastegar SM, Kiani A et al (2010) Avoiding cardiopulmonary bypass in extracardiac cavopulmonary connection: does it really matter? J Thorac Cardiovasc Surg 139:1183–1188PubMedCrossRefGoogle Scholar
  10. 10.
    Tam VK, Miller BE, Murphy K (1999) Modified Fontan without use of cardiopulmonary bypass. Ann Thorac Surg 68:1698–1704PubMedCrossRefGoogle Scholar
  11. 11.
    Azakie A, McCrindle BW, Van Arsdell G et al (2001) Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 122:1219–1228PubMedCrossRefGoogle Scholar
  12. 12.
    Knott-Craig CJ, Danielson GK, Schaff HV, Puga FJ, Weaver AL, Driscoll DD (1995) The modified Fontan operation: an analysis of risk factors for early postoperative death or takedown in 702 consecutive patients from one institution. J Thorac Cardiovasc Surg 109:1237–1243PubMedCrossRefGoogle Scholar
  13. 13.
    Seghaye MC, Duchateau J, Grabitz RG et al (1993) Complement activation during cardiopulmonary bypass in infants and children: relation to postoperative multiple system organ failure. J Thorac Cardiovasc Surg 106:978–987PubMedGoogle Scholar
  14. 14.
    Tarnok A, Hambsch J, Emmrich F et al (1999) Complement activation, cytokines, and adhesion molecules in children undergoing cardiac surgery with or without cardiopulmonary bypass. Pediatr Cardiol 20:113–125PubMedCrossRefGoogle Scholar
  15. 15.
    Tarnok A, Schneider P (2001) Pediatric cardiac surgery with cardiopulmonary bypass: pathways contributing to transient systemic immune suppression. Shock 16(Suppl 1):24–32PubMedCrossRefGoogle Scholar
  16. 16.
    Kawahira Y, Uemura H, Yagihara T (2006) Impact of the off-pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg 81:685–689PubMedCrossRefGoogle Scholar
  17. 17.
    Seghaye MC, Grabitz RG, Duchateau J et al (1996) Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations. J Thorac Cardiovasc Surg 112:687–697PubMedCrossRefGoogle Scholar

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

Personalised recommendations