Definitions:
The length of hospital stay was defined as the time between the
operation and the discharge of the patient. Re-hospitalization was
defined as hospitalization within 30 days after the discharge of the
patient postoperativelyfrom the hospital. Prolonged drainage was defined
as chest tube duration more than a week. Cardiopulmonary resuscitation
(CPR), need forextracorporeal membrane oxygenator (ECMO),
atrioventricular(AV) block requiring permanent pacemaker (PM)
implantation, diaphragm paralysis, neurological complication (persistent
at discharge), acute renal failure (ARF) and unplanned reoperation were
considered as MAE (7). Catheter interventions in the postoperative
period were defined as reintervention. Hospital mortality was defined as
mortality within the hospital or within the first 30 days
postoperatively.
Surgical Technique:
In our hospital, extracardiac (EC) Fontan procedure has been routinely
performedfor end-stage palliation. An intra-extracardiac (IEC)Fontan
operationwas performed only when standard extracardiac Fontan was not
feasible, typically asin patients with isomerismand unusual systemic and
pulmonary venous patterns. Procedures were performedunder normothermic
or mild hypothermic cardiopulmonary bypass. Cardioplegic arrest was used
only if concomittant intracardiac procedure was required. The pulmonary
arteries were reconstructed as necessary, using xenograft pericardium,
based on the cardiac catheterization and operative findings. The
threshold for pulmonary artery reconstruction was very low.
In our clinic, fenestration has notbeen performed routinely except in
high-risk patients (in case of atrioventricular valve regurgitation and
those with high PVR, end-diastolic pressure and delayed patients). Four
milimetres fenestrations were performed in patients with central venous
pressure (CVP) higher than 16 mmHg and transpulmonic gradient (TPG) more
than 12 mmHg at the end of the Fontan procedure. In addition, in
patients with a CVPvalue between 14-16 mmHg, fenestration was not
performed, instead the right atrium and Fontan tube were brought
together by a purse stich to be used for opening a fenestration via
transcatheter route if required. This region was also marked with
radio-opaque pacemaker wires to guide the possible
transcatheterintervention (Figure 1-4).