Thorac Cardiovasc Surg 2022; 70(S 02): S67-S103
DOI: 10.1055/s-0042-1742996
Oral and Short Presentations
Monday, February 21
DGPK TCPC

Fontan Fenestration: Postoperative Hemodynamic Relief or Additional Trauma and Cyanosis?

E. Petená
1   Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße, Hanover, Germany, Hannover, Deutschland
,
D. Bobylev
2   Carl-Neuberg-Straße 1, Hannover, Deutschland
,
D. Boetig
3   Hannover Medical School, Hannover, Deutschland
,
T. Cvitkovic
4   MHH, Carl Neuberg Straße 1, Hannover, Deutschland
,
V. Tsimashok
1   Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße, Hanover, Germany, Hannover, Deutschland
,
M. Avsar
5   Herz-, thorax-, transplantations-, gefäßchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland
,
S. Sarikouch
6   Carl-Neuberg-Str. 1, Hannover, Deutschland
,
H. Bertram
6   Carl-Neuberg-Str. 1, Hannover, Deutschland
,
P. Beerbaum
7   Medizinische Hochschule Hannover, Hannover, Deutschland
,
A. Haverich
2   Carl-Neuberg-Straße 1, Hannover, Deutschland
,
A. Horke
6   Carl-Neuberg-Str. 1, Hannover, Deutschland
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    Background: The real-life benefits of fenestration during Fontan procedure seem controversial. We aimed to compare the outcomes between fenestrated and nonfenestrated Fontan procedures.

    Method: In our center, we performed 43 Fontan operations from June 2011 to June 2021. We retrospectively analyzed these patients according to the presence or absence of fenestration, studied preoperative status, operative data, and postoperative course and compared them. We used Mann–Whitney U-test for comparisons.

    Results: A total of 22 patients received fenestration (group A) and 21 did not (group B). Thirteen patients in group A and 6 in group B had a morphologic hypoplastic left ventricle, 9 in group A and 14 in group B had a morphologic hypoplastic right ventricle, and 1 patient had a complex heart defect without a clear assignment. Three patients in group A underwent intracardiac Fontan process (p = 0.23). Two patients in group A, due to intraoperative circulatory insufficiency and congestion got an unplanned fenestration, and one patient of group B had a fenestration that needed to be intraoperative closed because of 80% saturation. Nine patients in group A and seven in group B underwent concomitant procedure (p = 0.75)

    Parameter

    Group A

    Group B

    p-Value

    Postoperative SO2%

    89.5% (IQR: 85–95)

    97% (IQR: 96– 97)

    <0.001

    ICU discharge SO2%

    89% (IQR: 84.5– 94)

    96% (IQR: 95 – 97)

    <0.001

    Additional drainage

    11

    9

    0.75

    Drainage freedom (d)

    8.5 (IQR: 7.5–11.5)

    9.5 (IQR: 7–14)

    0.518

    Prolonged catecholamine

    3

    1

    0.60

    Postoperative arrhythmia

    5

    0

    0.04

    Median ICU days

    5.5 (IQR: 4.5 –8)

    4 (IQR: 3–5.5)

    0.04

    Conclusion: Fenestrated Fontan patients had longer ICU stays, longer catecholamine support, and significantly less oxygen saturation. Fontan fenestration is therefore a procedure to perform only when there is clear indication.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    12 February 2022

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