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Eur J Cardiothorac Surg 2007;32:554. doi:10.1016/j.ejcts.2007.05.012
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Letters to the Editor

Reply to Goksel and Tireli

Department of Cardiac Surgery, Birmingham Children's Hospital, United Kingdom

Received 22 May 2007; accepted 23 May 2007.

^_* Corresponding author. Address: Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom. Tel.: +44 121 333 9435; fax: +44 121 333 9441. (Email: drriadhosein{at}hotmail.co.uk).

Key Words: Heart defects • Congenital • Paediatrics • Fontan procedure • Total cavopulmonary connection • Risk factors

We would like to thank Goksel and Tireli for their recent comments [1] on our recently published article [2]. We do not have any experience with off-pump surgery for cavopulmonary shunt or Fontan completion. This technique certainly has attractions of avoiding the potential deleterious effects of cardiopulmonary bypass as highlighted, particularly in terms of pulmonary vascular resistance and inflammatory response. It would be interesting to know the exact impact on the amount and duration of pleural drainage. Our greatest concern with the off-pump technique is that is does not really allow for any reconstruction or plasty of the pulmonary arteries, which frequently needs addressing at the time of surgery, particularly following the Norwood procedure. We prefer a bypass approach which is close to normothermia on the beating heart and feel this allows for accurate assessment of the PAs and where necessary augmentation and reconstruction. It also guarantees maintenance of cardiac output should there be problems with bleeding or accessing the IVC. We await further evidence to evaluate the benefits and risks of off-pump Fontan surgery.

References

1. Goksel OS, Tireli E. Letter to the Editor. Factors influencing early and late outcome following the Fontan procedure in the current era. Eur J Cardiothorac Surg 2007;32(3):553.[Free Full Text]
2. 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]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Riad B.M. Hosein David J. Barron William J. Brawn Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hosein, R. B.M. Articles by Brawn, W. J. Search for Related Content PubMed Articles by Hosein, R. B.M. Articles by Brawn, W. J. Related Collections Congenital - cyanotic