Circulation, Vol 86, 1762-1769, Copyright © 1992 by American Heart Association
ND Bridges, JE Mayer Jr, JE Lock, RA Jonas, FL Hanley, JF Keane, SB Perry and AR Castaneda
BACKGROUND. The "fenestrated Fontan" (surgical baffle fenestration followed
by transcatheter test occlusion and permanent closure after postoperative
recovery) was adopted in an effort to reduce perioperative mortality and
morbidity. This study assesses the effect of baffle fenestration on
outcome. METHODS AND RESULTS. Patients having a modified Fontan operation
with a cavocaval baffle and cavopulmonary anastomosis were retrospectively
selected for study. Those with baffle fenestration (n = 91) were compared
with those without baffle fenestration (n = 56) with respect to
preoperative risk factors, age, anatomy, surgical date, and presence or
absence of a previous bidirectional cavopulmonary anastomosis. Outcome
variables were failure (death or take-down) and duration of postoperative
pleural effusions and hospitalization. Survival and clinical status after
hospital discharge were ascertained. The two groups did not appear to
differ with respect to age or anatomic diagnosis. Patients having baffle
fenestration were at significantly greater preoperative risk by univariate
and multivariate analysis (p < 0.01). Operative failure was low in both
groups (11% without and 7% with baffle fenestration, p = NS). Durations of
pleural effusions and hospitalization were significantly shorter with
baffle fenestration (p < 0.01). Neither date of surgery nor a previous
bidirectional cavopulmonary anastomosis appeared to contribute to improved
outcome. Patients with baffle fenestration had lower postoperative systemic
venous pressure (p < 0.01). There were no late deaths. Functional status
in both groups is good (82% in New York Heart Association class I).
CONCLUSIONS. Baffle fenestration is associated with low mortality,
significantly less pleural effusion, and significantly shorter
hospitalization among high- risk patients having a modified Fontan
operation.
ARTICLES
Effect of baffle fenestration on outcome of the modified Fontan operation
Department of Cardiology, Children's Hospital, Boston.
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