• Su Wan Kim, Tae-Gook Jun, Ji-Hyuk Yang, Pyo Won Park, I-Seok Kang, June Huh, June Hurh, and Heung-Jae Lee.
• Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• J Card Surg. 2011 Sep 1; 26 (5): 509-14.

ObjectiveFactors related to prolonged pleural drainage after the Fontan operation have not been clearly defined. We investigated perioperative variables to establish factors predicting operative morbidity including prolonged chest tube drainage. Also, we pursued the fate of the fenestration during the follow-up period.MethodsWe retrospectively reviewed 52 patients who had undergone a fenestrated extracardiac Fontan procedure between August 1998 and June 2008. The median age at the time of surgery was 34.8 (range: 18.5 ∼ 156) months and the median body weight 13.2 kg (range: 9.5 ∼ 33). A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables for postoperative morbidity.ResultsOperative mortality occurred in one patient (1.9%). The mean duration of respiratory support, chest tube drainage, and hospital stay was 13 hours (range: 4 to 328 hours), six days (range: 2 to 45 days), and 16 days (range: 7 to 444 days), respectively. Statistically, an operation without previous bidirectional cavopulmonary shunt (OR 30, 95% CI 3.1 to 289) was the only independent risk factor for prolonged pleural drainage. Aortic cross-clamp time was identified as a risk factor for prolonged mechanical ventilatory support. During a median follow-up at 62 months (range: 17 to 137 months), there was one late death (1.9%). Twenty-two patients (43%) underwent intervention for fenestration closure.ConclusionsPrevious bidirectional cavopulmonary shunt and shortened aortic cross-clamp time may reduce postoperative morbidity including prolonged chest tube drainage and mechanical ventilator support after the fenestrated extracardiac conduit Fontan procedure. © 2011 Wiley Periodicals, Inc.

34 keywords...

hide…