The extracardiac lateral tunnel Fontan, constructed with bovine pericardium: Comparison with the extracardiac conduit Fontan

Lemler, Matthew S.; Ramaciotti, Claudio; Stromberg, Daniel; Scott, William A.; Leonard, Steven R.

doi:10.1016/j.ahj.2005.06.015

« Previous Next »American Heart Journal
Volume 151, Issue 4 , Pages 928-933, April 2006

The extracardiac lateral tunnel Fontan, constructed with bovine pericardium: Comparison with the extracardiac conduit Fontan

Matthew S. Lemler, MD
- Department of Pediatrics, The Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX
- Reprint requests: Matthew S Lemler, MD, Division of Cardiology, Children's Medical Center, 1935 Motor Street, Dallas, TX 75235.
Claudio Ramaciotti, MD
- Department of Pediatrics, The Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX
Daniel Stromberg, MD
- Department of Pediatrics, The Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX
William A. Scott, MD
- Department of Pediatrics, The Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX
Steven R. Leonard, MD
- Department of Cardiothoracic Surgery, The Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX

Received 6 April 2005; accepted 8 June 2005.

Background

The Fontan procedure performed with an extracardiac conduit (ECC) has gained wide acceptance as an alternative to the intracardiac lateral tunnel because it avoids placement of extensive atrial suture lines and use of prosthetic material in the systemic circulation. The extracardiac lateral tunnel (ELT) is a modification of the Fontan procedure which uses pericardium and the external surface of the atrium to create a conduit from the inferior vena cava to the pulmonary artery. This surgery theoretically avoids disruption of intra-atrial conduction by eschewing endocardial suturing while maintaining conduit growth potential and the ability to easily create a fenestration to the systemic circulation.

Methods

We retrospectively analyzed the short-term outcome of 96 consecutive patients who underwent an extracardiac Fontan procedure. An ELT using bovine pericardium was performed in 59 patients, whereas 37 patients received a traditional ECC.

Results

The 2 groups were similar with respect to age (P = .96), body surface area (P = .54), number of preoperative Fontan risk factors (P = .43), and ventricular morphology (P = .72). There were no significant differences in the following outcome variables between the ELT and the traditional ECC: length of hospitalization (P = .73), duration of chest tube drainage (P = .48), abnormal rhythm at time of discharge (P = .27), and mortality (P = .63).

Conclusions

The ELT Fontan can be performed with a low risk of mortality and complications. The results are equivalent to the traditional ECC procedure. The theoretical advantages of the procedure suggest that it should be considered a useful modification of Fontan surgery.