The Fontan-Operation: From Intra- to Extracardiac Procedure

Purpose: For treatment of univentricular heart. the Fontan operation has been established as the deflnitive palliation. The current controversy is mainly based on the high incidence of arrhythmias after an intra-atriai lateral tunnel Fontan operation. Methods: From January 1995 until April 2002. 46 children underwent a Fontan-type operation with or without a small fenestration. In 33 patients (group I) an intracardiac tunnel and in 13 patients (group II) an extracardiac conduit procedure was performed. Principal findings: There was no perioperative mortality. All patients showed postoperative a signiflcant increase of arterial oxygen saturation. from 76 to 86% after surgery with fenestration. or to 90.5% without fenestration respectively. In patients with fenestration procedure. the saturation rose to 90% after closure of fenestrations 9 to 12 months after operation. Conclusions: Modifled Fontan operations can be performed in normothermia on the beating heart with acceptable mortality. The extracardiac conduit Fontan procedure has the beneflts of less surgical IrlJury and a higher intraoperative flexibility. © 2003 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.

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