Open Access
ARTICLE
Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage
Ju Wang, Shuo Dong, Jun Yan*
Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
* Corresponding Author: Jun Yan. Email:
Congenital Heart Disease 2021, 16(5), 477-485. https://doi.org/10.32604/CHD.2021.015016
Received 16 November 2020; Accepted 13 January 2021; Issue published 03 June 2021
Abstract
Objective: Modifications of the Fontan operation, which are also known as total cavopulmonary connection
(TCPC), are widely applied for patients with functionally univentricular hearts (FUH). Herein, we summed up
the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition (ACJ) or/and
separated hepatic venous (SHV) drainage.
Methods: Between January 2009 and December 2019, 123 patients who
undergone TCPC in our institute were included in this retrospective study. We have included 70 patients with
ACJ (Group 1) and 53 patients with SHV (Group 2). Moreover, Group 2 included 17 cases combing with ACJ
(32.1%). In Group 1, three different TCPC methods were conducted. While 45 cases were conducted with the
extracardiac conduit-TCPC(EC-TCPC) method, 24 cases used the intracardiac conduit-TCPC(IC-TCPC)
method, and only one case used the lateral tunnel-TCPC(LT-TCPC). In Group 2, four TCPC methods were
conducted on patients. Forty cases used the EC-TCPC-common open technique, 6 cases with IC-TCPC
technique, 4 cases with LT-TCPC, and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).
Results: There
were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization
(
p < 0.05). Postoperative mean pulmonary artery pressure (mPAP) greater than 15 mmHg emerged as a predictor
for early re-operation (
p < 0.01) and early death (
p < 0.001) in univariate analysis.
Conclusions: TCPC can be
performed in these patients and shows beneficial results. Under the Fontan principle of connecting systemic
venous to the pulmonary vasculature unimpededly, surgeons should carefully evaluate three components when
choosing for the surgical technique: The distance between inferior vena cava (IVC) and the apex; the site of
the vertebrae relative to the ACJ; the distance between ACJ and SHV if coexisting. However, the technique should
be altered when the postoperative mPAP was greater than 15 mmHg.
Keywords
Cite This Article
Wang, J., Dong, S., Yan, J. (2021). Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage.
Congenital Heart Disease, 16(5), 477–485. https://doi.org/10.32604/CHD.2021.015016