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Extracardiac Fontan: Comparison of Fenestrated with non Fenestrated Patients
Andrew C. Fiore1, Mark Ruzmetov2, Corinne Tan1, *Mark D. Rodefeld2, Mark W. Turrentine2, John W. Brown2
1St.Louis University School of Medicine, St.Louis, MO;2Indiana University School of Medicine, Indianapolis, IN
BACKGROUND: Fenestration for the extracardiac Fontan (ECF) remains controversial. Fenestration may be related to less pleural drainage and shorter hospital stay, but at the expense of prolonged cyanosis and increased risk of paradoxical embolism.
METHODS: To assess fenestration utility, we retrospectively compared 85 consecutive ECF patients from July 1995 to October 2007 undergoing fenestration (Group F, 39 patients) with non fenestration (Group NF; 46 patients). Preoperatively, cohorts were similar in age, body surface area, ventricular dominance, end-diastolic pressure, oxygen saturation, McGoon ratio and bypass time. Non fenestrated patients were followed longer (F, 28 months; NF, 44 months; P<0.03). Group F received Coumadin and aspirin; NF, aspirin only. Fenestration patency was 85%. Groups were compared using Chi Square and Student t test.
RESULTS: Comparisons at follow up are shown in the Table. These data suggest fenestration of the ECF did not decrease readmission for chylothorax, protect patients from Fontan takedown or reduce early and late mortality. Despite similar pre operative risk variables, fenestration of the ECF was associated with greater total pleural drainage. NF patients experienced higher O2 saturation and a similar frequency of neurologic events and hospital stay.
CONCLUSIONS: This study demonstrates that in the current era fenestration of the ECF should be highly selective, as fenestration does not decrease adverse postoperative outcomes, mortality or hospital stay and is associated with long-term lower systemic oxygen saturation.
| F (N=39) | NF (n=46) | P value | | Pre op TP gradient (mmHg) | 4.5+/-2 | 5+/-2 | NS | | Post op O2 sat (%) | 89+/-7 | 94+/-6 | <0.05 | | Total chest tube loss (ml) | 3675+/-2709 | 1737+/-2045 | <0.02 | | Readmit for chyle N (%) | 6 (15) | 4 (9) | NS | | Neuro event N (%) | 3 (8) | 8 (17) | NS | | Fontan takedown N (%) | 3 (8) | 2 (4) | NS | | Early mortality N (%) | 0 (0) | 1 (2) | NS | | Late mortality N (%) | 2 (5) | 2 (4) | NS |
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