Modified extracardiac total cavopulmonary connection without fenestration. Single centre report on 134 patients; Is the fenestration old fashioned?

Objectives: Fenestration during Fontan palliation has traditionally been used to decrease surgical mortality and morbidity and improve the long-term results.

Methods: Since 1998, 134 patients have undergone a modification of Fontan procedure in which an extracardiac inferior cavopulmonary conduit is used in combination with a previously staged bidirectional Glenn anastomosis, without a fenestration. We conducted a retrospective review of these patients.

Result: There was one early death. The Fontan pressure was 9.3±3.5mmHg. The transpulmonary gradient was 5.0±1.86. Median ICU stay was 5 days and median hospital stay was 16 days. Prolonged (>2weeks) pleura drainage occurred in 15 patients. There were two late deaths. A latest follow-up, no patient developed protein losing enteropathy.

Conclusions: The data support the “non-fenestration”strategy of modified Fontan palliation. Evolution in perioperative management strategy, in anaesthetic techniques and postoperative care make the approach to Fontan fenestration unnecessary.