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Does the off-pump Fontan procedure ameliorate the volume and duration of pleural and peritoneal effusions?

Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Japan

Received 4 October 2007; received in revised form 24 March 2008; accepted 28 April 2008.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. Tel.: +81 6 6833 5012; fax: +81 6 6872-7486. (Email: yagihara{at}hsp.ncvc.go.jp).

Objective: We initiated an off-pump Fontan procedure by using temporary bypass from the inferior vena cava to the atrium and advanced the procedure in selected patients by simply cross-clamping the inferior vena cava. We aimed to investigate whether the off-pump Fontan procedure could ameliorate the volume and duration of pleural and peritoneal effusion. Methods: We retrospectively reviewed 74 patients (aged <4 years) who underwent Fontan completion between January 2001 and December 2006. The patients were classified into the following two groups: a cardiopulmonary bypass group in which cardiopulmonary bypass was required (n = 27) and an off-pump group in which the procedure was completed without the use of cardiopulmonary bypass (n = 47). A propensity score was used to control the treatment selection bias for the use of cardiopulmonary bypass. Fourteen patients from each group were successfully matched. Both bilateral pleural and peritoneal drainage tubes were placed in all the patients. The total volume of the effusion was measured at 6, 12, 24, 48, and 72 h postoperatively and was corrected for body weight (kg) and intervals (h). Results: Significantly reduced effusion (ml/kg/h) was noted in the off-pump group compared to the cardiopulmonary bypass group at 12 h (cardiopulmonary bypass group, 8.6 [4.8–11.5]; off-pump group, 2.5 [1.2–5.4]; p = 0.006) and at 48 h (cardiopulmonary bypass group, 6.1 [2.6–9.9]; off-pump group, 1.4 [0.9–3.1]; p = 0.008). Conclusions: The off-pump Fontan procedure may reduce the volume of postoperative pleural and peritoneal effusion.

Key Words: Off-pump Fontan • Pleural effusion • Morbidity • Extracardiac total cavopulmonary connection (TCPC) • Staged Fontan