Thorac Cardiovasc Surg 2013; 61 - V22
DOI: 10.1055/s-0033-1354450

Lateral Atrial Tunnel and Extracardiac Conduit in Fontan Operation – Comparison of Early Results

K Januszewska 1, A Schuh 2, A Lehner 2, M Riester 2, R Dalla-Pozza 2, R Kozlik-Feldmann 2, S Greil 2, E Malec 1
  • 1Universitätsklinikum Münster, Department für Herz- und Thoraxchirurgie, Abteilung für Kinderherzchirurgie
  • 2Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin, Ludwig-Maximilian Universität in München

Background: After more than 40 years history of Fontan operation (FO), two modifications are currently used: lateral atrial tunnel (LT) or extracardiac conduit (EC). The aim of the study was to compare the hospital outcomes of LT and EC.

Methods: Between 2007 and 2012, a series of 149 consecutive children at the mean age of 3.6 ± 2.1 years underwent FO: 56 (37.6%) patients after hemi-Fontan operation underwent fenestrated LT and 91 (61.1%) patients after bidirectional Glenn anastomosis underwent EC. Two (1.3%) patients underwent other variants of FO and were excluded. The most common malformations were hypoplastic left heart syndrome (55.1%) and hypoplastic right heart syndrome (10.2%). Hemodynamic, electrocardiographic, and clinical perioperative data were retrospectively analyzed.

Results: The hospital mortality was 0%. There were no differences between the groups regarding age, weight, morphology of the single ventricle, preoperative cardiac catheterization values, and postoperative intubation time. Children after EC tended to stay longer in hospital (18.4 ± 9.6 days vs. 15.5 ± 8.2 days; p= 0.061) and had significantly longer right pleural drainage for effusions (9.2 ± 7.1 days vs. 5.9 ± 5.0 days; p < 0.01). Patients after LT had more frequently junctional or ectopic atrial rhythm on the day of the operation (p < 0.01) and at discharge (p= 0.016).

Conclusions: Fenestrated lateral atrial tunnel seems to facilitate the early adaptation to Fontan physiology, but in our experience, this operative technique caused higher incidence of atrial rhythm disturbances, which can influence the late functional status of the patients.