Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY28. Fenestration During Fontan Palliation: Now the Exception Insteadof the RuleJorge D. Salazar, Kashif Siddiqui, Farhan Zafar, Ryan Coleman, David L. Morales,Jeffrey Heinle, Charles D. Fraser *Congenital Heart Surgery, Texas Children’s Hospital, Houston, TX, USAInvited Discussant: Scott M. BradleyOBJECTIVE: Fenestration during Fontan palliation has been employed todecrease surgical morbidity and mortality, particularly in high-risk patients. Thoughfenestration allows for maintenance of cardiac output and decompression of theFontan circuit, its limitations include oxygen desaturation, risk of paradoxicalembolism, and potential need for later intervention. Recognizing these factors, ourpractice has evolved away from routine fenestration of the Fontan connection. Thepurpose of this study was to review one institution’s experience with Fontan palliationand assess both short and long-term outcomes in the setting of decreased fenestrationutilization.MONDAYAfternoonMETHODS: Between January 2002 and April 2008, 209 patients underwent primaryFontan palliation. Outcomes in this retrospective cohort study were assessedby ICU and hospital length of stay, as surrogates for early morbidity (includingpleural effusions), and early and late mortality. No patients were discharged homewith a chest drain in place.RESULTS: Prominent morphologies were hypoplastic left heart syndrome (41;20%), heterotaxy syndrome (38; 18%), tricuspid atresia (37; 18%) and double-inletleft ventricle (35; 17%). A lateral tunnel connection was created in 67 patients(32%), and an extra-cardiac connection was created in 142 patients (68%), withextracardiac connections used increasingly in recent years and exclusively in 2008.Concomitant AV valve repair was performed in 15 (7%) patients. Mean age andweight at time of surgery were 5 ± 5 yrs and 18 ± 11 kg respectively.In 2002, 14 of 16 patients (88%) received a fenestrated Fontan circulation, comparedto 0 patients in 2008. Mean ICU and total hospital length of stay for allpatients were 3.5 ± 4.0 and 10.9 ± 9.0 days. Survival to hospital discharge or 30 dayswas 99% (206/209). There have been no late deaths in up to 6 year follow-up. Atotal of 6 patients (3%) required pacemaker insertion, and no strokes occurred.When comparing these selected outcome measures between years, no significantdifferences were noted (p = NS). See Table.* AATS Member119