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Extracardiac conduit Fontan procedure versus intra-atrial lateral tunnel Fontan procedure

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Abstract

The Fontan procedure has provided excellent surgical palliation for patients with various types of univentricular hearts, and it has evolved over time. Among many modifications, the lateral tunnel Fontan connection (LTF) and the extracardiac Fontan connection (ECF) are currently the most popular techniques for completing the total cavopulmonary connection. The advantages and disadvantages of both techniques are reviewed here. The advantages of the ECF includes adaptability to all types of univentricular hearts, ease of construction without aortic cross clamping and fewer atrial suture lines. The advantages of the LTF include the ability to complete Fontan circulation in young, very small patients with potential for growth. This review also compares post-operative arrhythmias and fluid dynamics associated with both techniques.

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References

  1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971;26:240–8.

    Article  PubMed  CAS  Google Scholar 

  2. Kreutzer GO, Vargas FJ, Schlichter AJ, Laura JP, Suarez JC, Coronel AR, Kreutzer EA. Atriopulmonary anastomosis. J Thorac Cardiovasc Surg. 1982;83:427–36.

    PubMed  CAS  Google Scholar 

  3. Mavroudis C, Backer CL, Deal BJ, Stewart RD, Franklin WH, Tsao S, Ward K. Evolving anatomic and electrophysiologic considerations associated with Fontan conversion. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2007;10:136–45.

    Article  Google Scholar 

  4. 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;76:53–60.

    Google Scholar 

  5. de Leval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Expermental studies and early clinical experience. J Thorac Cardiovasc Surg. 1988;96:682–95.

    PubMed  Google Scholar 

  6. Hashimoto K, Kurosawa H, Tanaka K, Yamagishi M, Koyanagi K, Ishii S, Nagahori R. Total cavopulmonary connection without the use of prosthetic material: technical considerations and hemodynamic consequences. J Thorac Cardiovasc Surg. 1995;110:625–32.

    Article  PubMed  CAS  Google Scholar 

  7. Stamm C, Friehs I, Duebener LF, Zurakowski D, Mayer JE Jr, Jonas RA, del Nido PJ. Improving results of the modified Fontan operation in patients with heterotaxy syndrome. Ann Thorac Surg. 2002;74:1967–77.

    Article  PubMed  Google Scholar 

  8. Fishberger SB, Wemovsky G, Gentles TL, Gauvreau K, Bumett J, Mayer JE Jr, Walsh EP. Factors that influence the development of atrial flutter after the Fontan operation. J Thorac Cardiovasc Surg. 1997;113:80–6.

    Article  PubMed  CAS  Google Scholar 

  9. Marcelletti C, Como A, Gianicco S, Marino B. Inferior cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg. 1990;100:228–32.

    PubMed  CAS  Google Scholar 

  10. Gianicco S, Hammad F, Amedeo A, Michielon G, Drago F, Turchetta A, DiDonato R, Sanders SP. Clinical outcome of 193 extracardiac Fontan patients. J Am Coll Cardiol. 2006;47:2065–73.

    Article  Google Scholar 

  11. Bove EL, Thomas R. Staged reconstruction for hypoplastic left heart syndrome: contemporary results. Ann Surg. 1996;224:387–95.

    Article  PubMed  CAS  Google Scholar 

  12. Norwood WI, Jacobs ML, Murphy JD. Fontan procedure for hypoplastic left heart syndrome. Ann Thorac Surg. 1992;54:1025–9.

    Article  PubMed  Google Scholar 

  13. Bridges ND, Lock JE, Castaneda AR. Baffle fenestration with subsequent transcatheter closure. Modification of the Fontan operation for the patients at increased risk. Circulation. 1990;82:1681–9.

    Article  PubMed  CAS  Google Scholar 

  14. Azakie A, McCrindle BW, Arsdell GV, Benson LN, Coles J, Hamilton R, Freedom RM, Williams WG. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact of outcomes. J Thorac Cardiovasc Surg. 2001;122:1219–28.

    Article  PubMed  CAS  Google Scholar 

  15. Nakano T, Kado H, Tachibana T, Hinokiyama K, Shiose A, Kajimoto M, Ando Y. Excellent midterm outcome of extracardiac conduit total cavopulmonary connection: results of 126 cases. Ann Thorac Surg. 2007;84:1619–26.

    Article  PubMed  Google Scholar 

  16. Fiore AC, Turrentine M, Rodefeld M, Vijay P, Schwartz L, Virgo S, Fischer LK, Brown JW. Fontan operation: comparison of lateral tunnel with extracardiac conduit. Ann Thorac Surg. 2007;83:622–30.

    Article  PubMed  Google Scholar 

  17. Hakacova N, Lakomy M, Kovacikova L. Arrhythmias after Fontan operation: comparison of lateral tunnel and extracardiac conduit. J Electrocardiol. 2008;41:173–7.

    Article  PubMed  Google Scholar 

  18. Kumar SP, Rubinstein CS, Simsic JM, Taylor AB, Saul JP, Bradley SM. Lateral tunnel versus extracardiac conduit Fontan procedure: aconcurrent comparison. Ann Thorac Surg. 2003;76:1389–97.

    Article  PubMed  Google Scholar 

  19. Hirsch JC, Goldberg C, Bove EL, Salehian S, Lee T, Ohye RG, Devaney EJ. Fontan operation in the current era: a 15-year single institution experence. Ann Surg. 2008;248:402–10.

    PubMed  Google Scholar 

  20. Brown JW, Ruzmetov M, Deschner BW, Rodefeld MD, Turrentine MW. Lateral tunnel Fontan in the current era: is it still a good option? Ann Thorac Surg. 2010;89:556–63.

    Article  PubMed  Google Scholar 

  21. Lardo AC, Webber SA, Friehs I, del Nido P, Cape EG. Fluid dynamics comparison of intra-atrial and extracardiac total cavopulmonary connections. J Thorac Cardiovasc Surg. 1999;117:697–704.

    Article  PubMed  CAS  Google Scholar 

  22. Bove EL, de Leval MR, Migliavacca F, Guadagni G, Dubini G. Computational fluid dynamics in the evaluation of hemodynamic performance of cavopulmonary connections after the Norwood procedure for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2003;126:1040–7.

    Article  PubMed  Google Scholar 

  23. Nakamura Y, Yagihara T, Kagisaki K, Hagino I, Kobayashi J. Pulmonary arteriovenous malformations after a Fontan operation in the left isomerism and absent inferior vena cava. Euro J Cardiothorac Surg. 2009;36:69–76.

    Article  Google Scholar 

  24. Dasi LP, Whitehead K, Pekkan K, Zelicourt D, Sundareswaran K, Kanter K, Fogel MA, Yoganathan AP. Pulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac. J Thorac Cardiovasc Surg. 2011;141:207–14.

    Article  PubMed  Google Scholar 

  25. Stewart RD, Pasquali SK, Jacobs JP, Benjamin DK, Jaggers J, Cheng J, Mavroudis C, Lacobs MJ. Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection. Ann Thorac Surg. 2012;93:1254–61.

    Article  PubMed  Google Scholar 

  26. Ohuchi H, Kagisaki K, Miyazaki A, Kitano M, Yazaki S, Sakaguchi H, Ichikawa H, Yamada O, Yagihara T. Impact of the evolution of the Fontan operation on early and late mortality: a single-center experence of 405 patients over 3 decades. Ann Thorac Surg. 2011;92:1457–67.

    Article  PubMed  Google Scholar 

  27. Ochiai Y, Imoto Y, Sakamoto M, Kajiwara T, Sese A, Watanabe M, Ohno T, Joo K. Mid-term follow-up of the status of Gore-tex graft after extracardiac conduit Fontan procedure Euro. J Cardiothorac Surg. 2009;36:63–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Saitama Medical University, Saitama International Medical Center, 1397-1, Yamane, Hidaka, Saitama, Japan

    Toshiyuki Katogi

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  1. Toshiyuki Katogi
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Correspondence to Toshiyuki Katogi.

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The review was submitted at the invitation of the editorial committee.

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Katogi, T. Extracardiac conduit Fontan procedure versus intra-atrial lateral tunnel Fontan procedure. Gen Thorac Cardiovasc Surg 60, 792–795 (2012). https://doi.org/10.1007/s11748-012-0161-9

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  • DOI: https://doi.org/10.1007/s11748-012-0161-9

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