Extracardiac fontan with direct cavopulmonary connections: midterm results

Background: The aim of this study was to analyze the midterm results following direct superior and inferior cavopulmonary connections (DCPC) to create Fontan circulation in patients with functionally univentricular hearts.

Methods: Retrospective review of patients operated between January 2005 and May 2011.

Results: The 25 consecutive patients who underwent this type of operation were retrospectively reviewed. There were 15 (60%) males and ten (40%) females, with median age of 73 months (range: 16-150 months) and median weight of 25 kg (range: 11-46 kg). Aortic cross-clamping used in ten patients, with median cross-clamp time of 40 minutes (range: 23-99) and median cardiopulmonary bypass (CPB) time of 135 minutes (range: 76-179 minutes). The remaining 15 patients were operated without aortic cross-clamping. Their median CPB time was 112 minutes (range: 82-139 minutes). Fenestration was performed in 15 cases. Associated intracardiac procedures were performed on ten patients. The follow-up period ranged from two months to six years. Operative mortality and late mortality after discharge were zero. Major postoperative complications included supraventricular tachycardia in one patient, oliguria and peritoneal dialysis in one patient, chest drainage persisting more than seven days in five patients (20%). One patient developed sinus bradycardia in association with sinus pauses two months after discharge. One patient developed pericardial effusion one month after discharge.

Conclusions: Direct superior and inferior cavopulmonary connections to create Fontan circulation in appropriately selected patients with functionally univentricular hearts can be performed with low risk and a low rate of reintervention. The midterm results are favorable.