|
|
Feasibility of the Extracardiac Conduit Fontan Operation in Fontan Candidates with Less Than Ten Kilograms Body Weight
A. Ikai, Y. Fujimoto, K. Hirose, N. Ota, Y. Tosaka, T. Nakata, Y. Ide, K. Sakamoto. Shizuoka children's Hospital, Shizuoka, Japan,
OBJECTIVE: Widespread use of the extracardiac conduit Fontan procedure (ECCF), has improved outcomes. However, its application is considered to be limited to larger patients, since conduit size and patient size need to match. Early elimination of cyanosis, however, should be advantageous in Fontan candidates. Recently, we have performed ECCF in patients even with body weights under 10 kilograms (kg). The aim of our study is to evaluate the feasibility of the ECCF in patients of small body size and young age.
METHODS: Since January 1999, 72 consecutive patients weighing less than 20 kg underwent ECCF using polytetrafluoroethylene (PTFE) conduits. The patients were divided into two equal groups based on body weight, with 36 patients each under 10 kg (group S) and over 10 kg (group L). Mean weight in groups S and group L was 8.4 ±1.1 and 14.0 ± 3.0 kg, median age 18.9 vs. 42.0 months, median follow up periods 29.2 (1.7 - 79.7) and 42.1 (2.8 - 94.2) months, respectively. Postoperatively, the majority of patients received peritoneal drainage (PD) catheters. We reviewed preoperative catheterization data and postoperative course (duration of ventilator support, chest tube (CT) and PD drainage, and ICU stay). We also reviewed postoperative catheterization data obtained in 28 patients in group S and 29 in group L.
RESULTS: PTFE conduit diameters were 16 mm in (n=20), 18 mm (n=13), 20 mm (n=3) in group S and 14 mm (n=1), 16 mm (n=15), 18 mm (n=6), and 20 mm (n=14) in group L. Cardiopulmonary bypass time in group S and L was 147 ± 55 minutes and 168 ± 51 minutes (p=0.057), respectively. Three patients in group S and two patients in group L required fenestrations. There were two hospital deaths, one in each group. There were two late deaths in group S due to infection. There was no significant difference in postoperative course between two groups: Group S vs. group L: ventilator support median 10 vs. 8 hours; CT drainage mean 10.3 vs. 10.0 days; >14 days CT drainage 6 vs. 5 cases; PD mean 7.7 vs. 8.7 days; ICU stay mean 8.2 vs. 5.8 days, respectively. There was no significant difference in Glenn and Fontan pressures: Group S vs. group L: Glenn 12.7 ± 3.0 vs. 12.1 ± 2.2 mmHg; Fontan 12.5 ± 2.4 vs. 12.8 ± 2.2 mmHg.
CONCLUSIONS: The early outcome of the ECCF in this patient group of young age and small body size was satisfactory. However, the required size of the extracardiac conduit is still disputable. ECCF in patients with small body size might be feasible to eliminate cyanosis earlier in life.
Back to 33rd Annual Meeting
Back to Program Outline
|
