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The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma

Our programmatic approach to the Fontan operation has evolved to include using an extracardiac conduit with aggressive presumptive treatment of associated lesions either in the catheterization laboratory or the operating room. Fenestration is used selectively based on hemodynamics, anatomy, and pres...

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Autores principales: Hannan, Robert L., Zabinsky, Jennifer A., Salvaggio, Jane L., Rossi, Anthony F., Khan, Danyal M., Alonso, Francisco A., Ojito, Jorge W., Nykanen, David G., Zahn, Evan M., Burke, Redmond P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer-Verlag 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139070/
https://www.ncbi.nlm.nih.gov/pubmed/21479823
http://dx.doi.org/10.1007/s00246-011-9973-0
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author Hannan, Robert L.
Zabinsky, Jennifer A.
Salvaggio, Jane L.
Rossi, Anthony F.
Khan, Danyal M.
Alonso, Francisco A.
Ojito, Jorge W.
Nykanen, David G.
Zahn, Evan M.
Burke, Redmond P.
author_facet Hannan, Robert L.
Zabinsky, Jennifer A.
Salvaggio, Jane L.
Rossi, Anthony F.
Khan, Danyal M.
Alonso, Francisco A.
Ojito, Jorge W.
Nykanen, David G.
Zahn, Evan M.
Burke, Redmond P.
author_sort Hannan, Robert L.
collection PubMed
description Our programmatic approach to the Fontan operation has evolved to include using an extracardiac conduit with aggressive presumptive treatment of associated lesions either in the catheterization laboratory or the operating room. Fenestration is used selectively based on hemodynamics, anatomy, and presence of associated lesions. We reviewed our experience to determine the effectiveness and outcome of this strategy and to assess the cumulative trauma to the patients. The records of 137 consecutive patients who underwent Fontan at Miami Children’s Hospital from 1995 to 2008 were reviewed. At mean follow up of 5.76 years, freedom from death or transplantation is 94.2% (129/137). Median age at operation was 4.6 years. Longer length of stay correlated with older operative age (P = 0.0056). Pacemakers were implanted in 11.7% (16/137). Additional (not pre-Glenn or pre-Fontan) interventional catheterizations were performed in 51.8% (71/137). Additional operations were done in 10.2% (14/137). No patient has required replacement or revision of the extracardiac conduit. Our current approach to the Fontan operation provides acceptable midterm results. The pursuit of residual lesions results in a significant number of additional interventional catheterizations and operative procedures but might have an important influence on long-term survival after the Fontan procedure.
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spelling pubmed-31390702011-08-26 The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma Hannan, Robert L. Zabinsky, Jennifer A. Salvaggio, Jane L. Rossi, Anthony F. Khan, Danyal M. Alonso, Francisco A. Ojito, Jorge W. Nykanen, David G. Zahn, Evan M. Burke, Redmond P. Pediatr Cardiol Original Article Our programmatic approach to the Fontan operation has evolved to include using an extracardiac conduit with aggressive presumptive treatment of associated lesions either in the catheterization laboratory or the operating room. Fenestration is used selectively based on hemodynamics, anatomy, and presence of associated lesions. We reviewed our experience to determine the effectiveness and outcome of this strategy and to assess the cumulative trauma to the patients. The records of 137 consecutive patients who underwent Fontan at Miami Children’s Hospital from 1995 to 2008 were reviewed. At mean follow up of 5.76 years, freedom from death or transplantation is 94.2% (129/137). Median age at operation was 4.6 years. Longer length of stay correlated with older operative age (P = 0.0056). Pacemakers were implanted in 11.7% (16/137). Additional (not pre-Glenn or pre-Fontan) interventional catheterizations were performed in 51.8% (71/137). Additional operations were done in 10.2% (14/137). No patient has required replacement or revision of the extracardiac conduit. Our current approach to the Fontan operation provides acceptable midterm results. The pursuit of residual lesions results in a significant number of additional interventional catheterizations and operative procedures but might have an important influence on long-term survival after the Fontan procedure. Springer-Verlag 2011-04-10 2011 /pmc/articles/PMC3139070/ /pubmed/21479823 http://dx.doi.org/10.1007/s00246-011-9973-0 Text en © The Author(s) 2011 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
spellingShingle Original Article
Hannan, Robert L.
Zabinsky, Jennifer A.
Salvaggio, Jane L.
Rossi, Anthony F.
Khan, Danyal M.
Alonso, Francisco A.
Ojito, Jorge W.
Nykanen, David G.
Zahn, Evan M.
Burke, Redmond P.
The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title_full The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title_fullStr The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title_full_unstemmed The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title_short The Fontan Operation: The Pursuit of Associated Lesions and Cumulative Trauma
title_sort fontan operation: the pursuit of associated lesions and cumulative trauma
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139070/
https://www.ncbi.nlm.nih.gov/pubmed/21479823
http://dx.doi.org/10.1007/s00246-011-9973-0
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