Abstract 9296: Three-Stage Fontan Without Cardiopulmonary Bypass
Objectives: The 3-stage surgical approach is now accepted as the gold standard for management of children born with functional single ventricle. However, there is little consensus on the cardiopulmonary bypass strategies employed for these procedures. We have attempted to avoid cardiopulmonary bypass in single ventricle patients whenever possible to eliminate the adverse effects that are induced by this process. The purpose of this study was to review our experience in patients who underwent all 3 stages of the Fontan pathway without ever being exposed to bypass.
Methods: 52 single ventricle patients underwent "off-pump" treatment at all 3 stages of their surgical management. The time period of the study was from 2002 to 2013. There were 31 males and 21 females. Anatomic diagnoses included: double outlet left ventricle (n=11), pulmonary atresia with intact ventricular septum (n=11), tricuspid atresia (n=10), double outlet right ventricle (n=9), and other (n=11).
42 of 52 patients underwent a neonatal off-pump palliative procedure, including systemic-to-pulmonary artery shunt in 33 and pulmonary artery band in 9. 52 patients underwent an off-pump bi-directional Glenn: 38 had a single superior vena cava (facilitated by construction of a veno-venous shunt) and 14 had bilateral superior vena cavae. All 52 patients underwent an off-pump extra-cardiac conduit Fontan.
Results: There was no operative mortality in the 52 patients undergoing Fontan completion. The patients have been followed for an average of 5.1± 2.5 years, with one late mortality. The median length of hospital stay for the 3 stages was 17, 5, and 9 days, respectively. 47 of the 52 patients were able to undergo all 3 stages without the need for a blood transfusion.
Conclusions: This series demonstrates the feasibility of achieving a Fontan circulation without patients exposed to cardiopulmonary bypass. There was no operative mortality and very low mid-term mortality, and it is notable that less than 10% of patients ever had a blood transfusion. We believe that elimination of cardiopulmonary bypass does have clinical benefits in this highly select subset of single ventricle patients.
- © 2013 by American Heart Association, Inc.