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Eur J Cardiothorac Surg 2007;32:553. doi:10.1016/j.ejcts.2007.05.011
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Factors influencing early and late outcome following Fontan procedure in the current era

Onur S. Goksel*, Emin Tireli

University of Istanbul, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Istanbul, Turkey

Received 5 April 2007; accepted 23 May 2007.

* Corresponding author. Address: 4. Gazeteciler Sitesi, C3 Blok, Da: 16, 80620 1. Levent, Istanbul, Turkey. Tel.: +90 532 795 91 18; fax: +90 212 530 64 08. (Email: onurgokseljet{at}gmail.com).

Key Words: Heart defects • Congenital • Pediatrics • Fontan procedure • Total cavopulmonary connection

We read with great interest the article by Hosein et al. [1] on the early and late outcome after Fontan procedure. They reviewed their cumulative experience with 406 consecutive patients who underwent Fontan procedure with cardiopulmonary bypass over a 16-year-long period. We would like to congratulate the authors for their in-depth analysis with an overall early mortality rate of 4.4% and 5-year survival rate of 90 ± 2% in a heterogeneous group of patients and procedures. Preoperative low ejection fraction and high pulmonary artery pressure were identified as the sole predictors for worse outcome. Since 1996, our group performs cavopulmonary shunts and Fontan procedures exclusively off-pump in all patients unless an intracardiac repair is indicated [2–4]. In our experience with a relatively smaller group of patients, the surgical technique of off-pump extracardiac Fontan procedure influences the outcome by reducing perioperative vasopressor needs, shorter intubation and intensive care/hospital stay rather than mortality [2,3]. Within 20 consecutive off-pump extracardiac Fontan procedures with no conversion to bypass, we observed two cases of mortality; they had preoperative pulmonary artery pressures of 18 and 13 mmHg, the latter having a preoperative ejection fraction of 45%. This observation is consistent with the findings by Hosein et al. [1]. Long-term pleural effusion and arrhythmia rates are also significantly reduced with off-pump extracardiac technique in addition to other known immediate advantages of avoidance from cardiopulmonary bypass in low-to-high risk groups [4,5].

We would like to thank the authors for the comprehensive review and the risk factor analysis.

References

  1. Hosein RBM, Clarke AJB, McGuirk SB, Griselli M, Stumper O, De Giovanni JV, Barron DJ, Brawn WJ. Factors influencing early and late outcome following Fontan procedure in the current era. The "two commandments"?. Eur J Cardiothorac Surg 2007;31:344-353.[Abstract/Free Full Text]
  2. Tireli E, Ugurlucan M, Basaran M, Kafali E, Harmandar B, Sayin OA, Sungur Z, Dayioglu E. Extracardiac Fontan operation without cardiopulmonary bypass. J Cardiovasc Surg (Torino) 2006;47:699-704.[Medline]
  3. Tireli E, Basaran M, Kafali E, Harmandar B, Camci E, Dayioglu E, Onursal E. Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt. Eur J Cardiothorac Surg 2003;23:518-524.[Abstract/Free Full Text]
  4. Korkut AK, Cetin G, Soyler I, Tireli E. Pleural effusion and off-pump Fontan procedure. J Thorac Cardiovasc Surg 2004;128:799.[Free Full Text]
  5. Kawahira Y, Uemura H, Yagihara T. Impact of the off pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg 2006;81:685-689.[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
R. B.M. Hosein, S. P. Mcguirk, D. J. Barron, and W. J. Brawn
Reply to Goksel and Tireli
Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 554 - 554.
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