Original ArticlesClinical Results of the Staged Fontan Procedure in High-Risk Patients
Section snippets
Patients and methods
A total of 108 patients underwent a modified Fontan procedure, total cavopulmonary connection, at Fukuoka Children’s Hospital between November 1991 and July 1996. In 68 patients a primary Fontan operation was done in a single stage fashion (primary group). In 40 patients a preliminary bidirectional Glenn shunt was first performed before the completion of the Fontan operation (staged group). The selection of the operative strategy in these patients mainly depended on the preoperative risk
Results
The myocardial ischemic time was significantly shorter in the staged group (41.1 ± 26.4 minutes) than in the primary group (57.1 ± 23.5 minutes), partially because of the frequent application of an extracardiac conduit in the staged group. The cardiopulmonary bypass time was also significantly shorter in the staged group (136.6 ± 42.6 minutes) than in the primary group (165.5 ± 54.3 minutes) because the bidirectional Glenn shunt had already been made in this group in addition to the shorter
Comment
The Fontan operation is a definitive palliation for complex cardiac anomalies with a functional single ventricle. In addition to completing the Fontan procedure, concomitant procedures such as plasty of the atrioventricular valve, plasty of the pulmonary artery, and the repair of anomalous pulmonary venous drainage are frequently required in such high-risk patients. Prolonged cardiopulmonary bypass time and myocardial ischemic time may increase the operative mortality and morbidity of these
Acknowledgements
We express our gratitude to Dr Shigeki Morita (Division of Cardiac Surgery, Kyushu University) and Brian Quinn (English Medical Editor, Kyushu University) for comments on the manuscript.
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