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Significance Statement:
Collaboration research between Utah and California and Stanford University Engineers proposing a new surgical intervention for children born with a single ventricle in their heart. The new proposed approach (Fontan procedure) would potentially reduce the number of surgeries the patients have to undergo in the first six months of life from two to just one. It promise a more stable circuit for blood to flow.
The Journal of Thoracic and Cardiovascular Surgery, nov 2014.
Martin MH, Feinstein JA, Chan FP, Marsden AL, Yang W, Reddy VM.
Department of Pediatrics (Cardiology), University of Utah, Salt Lake City, Utah &
Department of Radiology, Stanford University, Palo Alto, Calif &
Department of Mechanical and Aerospace Engineering, University of California, San Diego, La Jolla, Calif. &
Department of Pediatrics (Cardiology), Stanford University, Palo Alto, Calif.
ABSTRACT
Objectives
To demonstrate the technical feasibility and describe intermediate outcomes for the initial patients undergoing handcrafted, area-preserving, Y-graft modification of the Fontan procedure.
Methods
A retrospective review of a pilot study was undertaken to describe preoperative, intraoperative, and postoperative results.
Results
Six patients underwent successful procedures and remain alive 3 to 4 years later. The median age at operation was 3.3 years, and median weight was 13.2 kg. Five operations were done without cardiopulmonary bypass and no intraoperative pressure gradients were found. Five patients were extubated by postoperative day 1, Fontan pressures were 12 to 14 mm Hg, transpulmonary gradients were 6 to 8 mm Hg, and no renal or hepatic function abnormalities were found. Length of stay was 10 to 64 days. One patient required venovenous extracorporeal membrane oxygenation for previously undiagnosed plastic bronchitis (64-day stay); another required reoperation for an incidentally diagnosed aortic thrombus (44-day stay). One patient had occlusion of a Y-graft limb noted on magnetic resonance imaging follow-up at 3 months. Catheterization showed excellent hemodynamic parameters and no Fontan obstruction. Occlusion was believed to be due to right-sided pulmonary arteriovenous malformations and widely discrepant flow (80%) to the right lung leading to low flow in the left limb.
Conclusions
The area-preserving, bifurcated Y-graft Fontan modification is technically feasible and shows excellent intermediate outcomes. Additional study is required to determine whether the advantages seen in the computational models will be realized in patients over the long-term, and to optimize patient selection for each of the various Fontan options now available.
