Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: Serial changes in conduit geometry

Adachi, Iki; Yagihara, Toshikatsu; Kagisaki, Koji; Hagino, Ikuo; Ishizaka, Toru; Koh, Masahiro; Uemura, Hideki; Kitamura, Soichiro

doi:10.1016/j.jtcvs.2005.07.050

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 130, Issue 6 , Pages 1517-1522.e1, December 2005

Fontan operation with a viable and growing conduit using pedicled autologous pericardial roll: Serial changes in conduit geometry

Iki Adachi, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Toshikatsu Yagihara, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
- Address for reprints: Toshikatsu Yagihara, MD, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
Koji Kagisaki, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Ikuo Hagino, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Toru Ishizaka, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Masahiro Koh, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
Hideki Uemura, MD
- Department of Cardio-Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
Soichiro Kitamura, MD
- Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan

Received 9 April 2005; received in revised form 9 April 2005; accepted 9 April 2005.

Objective

We sought to examine midterm results of the Fontan operation with an extracardiac conduit using pedicled autologous pericardial roll, with special attention to angiographic evaluation of serial changes in conduit geometry.

Methods

Of 202 patients subjected to the Fontan operation since 1996, the conduit was used in 28 patients who had intact pericardium. We retrospectively reviewed a consecutive series of these patients, and serial changes in conduit geometry were accessed in 16 patients who underwent catheter examinations twice at 1.1 ± 0.4 and 4.5 ± 1.4 years postoperatively.

Results

There was one early and one late death. Except for a patient with apicocaval juxtaposition in whom a conduit occlusion developed caused by compression between the vertebral bodies and the ventricle, there were no important complications. Angiographically, conduit volume, estimated by using the MULTI-SLICE method, increased significantly (3490 ± 2166 to 5426 ± 3081 mm³, P < .001), whereas the volume per body weight remained unchanged. Conduit diameter increased significantly at both the inferior vena caval end (16.8 ± 4.8 to 19.8 ± 4.8 mm, P < .001) and the pulmonary artery end (11.9 ± 3.8 to 14.2 ± 4.2 mm, P < .001), whereas the diameter indexed to the normal right pulmonary artery remained unchanged. The cross-sectional area of the conduit increased in parallel with that of the normal right pulmonary artery. The ratio of the widest to the narrowest diameter of the conduit exhibited no significant change.

Conclusions

Midterm results of the Fontan operation with pedicled autologous pericardial roll were favorable. Proportional increase of conduit size was demonstrated, with its shape preserved. This suggested a potential of the conduit to grow and that growth correlated with somatic development.

Abbreviations and Acronyms: IVC, inferior vena cava, PA, pulmonary artery, PAPR, pedicled autologous pericardial roll, SVC, superior vena cava