| Fontan operation: a comparison of lateral tunnel with extracardiac conduit. | |
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MedLine Citation:
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PMID: 17257998 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The purpose of this report is to compare the outcome of the extracardiac (EC) with the lateral tunnel (LT) Fontan. METHODS: From January 1990 to October 2004, the Fontan operation was performed in 162 patients, of which 49 were EC and 113 were LT. Cardiac morphology and ventricular dominance were similar, except EC patients were older and had a greater frequency of heterotaxy syndrome, and LT patients had a higher incidence of hypoplastic left heart syndrome. Preoperative transpulmonary gradient, ventricular end-diastolic pressure, McGoon index, room air saturation, and cardiac rhythm were similar. EC patients underwent superior caval pulmonary connection, and LT patients underwent hemi-Fontan. Cardiopulmonary bypass time was similar, but fewer EC patients needed aortic cross-clamping. Fenestration was more frequent in LT patients (EC, 16% versus LT, 73%; p < 0.01). RESULTS: Overall operative mortality was 1.8% (EC, 1 versus LT, 2; p = NS). Postoperative transpulmonary gradient, readmission for chylous effusion, and change in ejection fraction relative to preoperative level did not differ between cohorts. Resource utilization was higher in the EC group. The loss of sinus rhythm and the frequency of all neurologic events did not differ. There were seven late deaths (EC 4 versus LT 3; p = NS). Actuarial survival at 5 years was not significantly different (EC, 90% versus LT, 95%; p = 0.08). CONCLUSIONS: The EC and LT operation had comparable early and late mortality, readmission for chylous effusion, preservation of sinus rhythm, and frequency of all neurologic events. The more frequently fenestrated LT cohort used fewer resources. |
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Authors:
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Andrew C Fiore; Mark Turrentine; Mark Rodefeld; Palaniswamy Vijay; Theresa L Schwartz; Katherine S Virgo; Laurice K Fischer; John W Brown |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 83 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2007 Feb |
Date Detail:
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Created Date: 2007-01-29 Completed Date: 2007-03-06 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 622-9; discussion 629-30 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiothoracic Surgery, St. Louis University School of Medicine/Cardinal Glennon Children's Hospital, St. Louis, Missouri 63104, USA. fiorem2@slu.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arrhythmias, Cardiac
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etiology Blood Pressure Child Child, Preschool Cohort Studies Female Follow-Up Studies Fontan Procedure / adverse effects, methods*, mortality Heart Defects, Congenital / physiopathology, surgery* Heart Rate Humans Incidence Infant Male Mitral Valve Insufficiency / etiology Nervous System Diseases / epidemiology, etiology Patient Readmission / statistics & numerical data Pericardial Effusion / etiology Postoperative Period Stroke Volume Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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