PMID- 16181885
OWN - NLM
STAT- MEDLINE
DCOM- 20060919
LR  - 20191210
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 80
IP  - 4
DP  - 2005 Oct
TI  - Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit.
PG  - 1445-51; discussion 1451-2
AB  - BACKGROUND: Since Fontan revision has been demonstrated to provide hemodynamic 
      and symptomatic improvement in select patients with failing Fontan circulations, 
      we now believe it is important to determine if one type of revision (lateral 
      tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes. METHODS: 
      Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) 
      and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) 
      IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 
      13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS). 
      Twenty-eight patients (80%) underwent a modified maze procedure (LT = 12 vs ECC = 
      16, p = NS) and 29 (83%) had pacemaker placement (LT = 11 vs ECC = 18, p < 0.05). 
      RESULTS: There were no hospital deaths and no arrhythmias at hospital discharge. 
      There were no differences in mean duration of intubation (LT 0.6 vs ECC 0.9 days, 
      p = NS), inotropic support (LT 1.5 vs ECC 2.1 days, p = NS), intensive care unit 
      stay (LT 2.6 vs ECC 3.5 days, p = NS), hospital stay (LT 8.8 vs ECC 9.7 days, p = 
      NS), or episodes of acute postoperative arrhythmias (LT = 2 vs ECC = 4, p = NS). 
      On intermediate follow-up (29 +/- 22 months), the overall cohort had 94% 
      survival, 97% of survivors in NYHA class I/II, 91% freedom from late arrhythmias 
      requiring medication, and no patient required cardiac transplantation. Follow-up 
      revealed no differences in NYHA I/II (LT = 14 vs ECC = 18, p = NS), mortality (LT 
      = 2 vs ECC = 0, p = NS), or late arrhythmia (LT = 4 vs ECC = 4, p = NS). 
      CONCLUSIONS: Both the LT and ECC revisions provide symptomatic benefit for a 
      failing Fontan connection and have equivalent early and intermediate results 
      including arrhythmia recurrence.
FAU - Morales, David L S
AU  - Morales DL
AD  - Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, 
      Texas Heart Institute, Baylor College of Medicine, Houston, Texas, USA. 
      dlmorale@texaschildrenshospital.org
FAU - Dibardino, Daniel J
AU  - Dibardino DJ
FAU - Braud, Brandi E
AU  - Braud BE
FAU - Fenrich, Arnold L
AU  - Fenrich AL
FAU - Heinle, Jeffrey S
AU  - Heinle JS
FAU - Vaughn, William K
AU  - Vaughn WK
FAU - McKenzie, E Dean
AU  - McKenzie ED
FAU - Fraser, Charles D Jr
AU  - Fraser CD Jr
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Arrhythmias, Cardiac/etiology/physiopathology/therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Fontan Procedure/adverse effects/*methods/statistics & numerical data
MH  - Hemodynamics
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Outcome and Process Assessment, Health Care
MH  - Retrospective Studies
MH  - Salvage Therapy/*methods/statistics & numerical data
MH  - Survival Analysis
MH  - Treatment Failure
EDAT- 2005/09/27 09:00
MHDA- 2006/09/20 09:00
CRDT- 2005/09/27 09:00
PHST- 2005/01/20 00:00 [received]
PHST- 2005/03/26 00:00 [revised]
PHST- 2005/03/28 00:00 [accepted]
PHST- 2005/09/27 09:00 [pubmed]
PHST- 2006/09/20 09:00 [medline]
PHST- 2005/09/27 09:00 [entrez]
AID - S0003-4975(05)00572-2 [pii]
AID - 10.1016/j.athoracsur.2005.03.112 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2005 Oct;80(4):1445-51; discussion 1451-2. doi: 
      10.1016/j.athoracsur.2005.03.112.