About this item:

616 Views | 23 Downloads

Author Notes:

Correspondence: Kirk R. Kanter, MD, Pediatric Cardiac Surgery, Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, Georgia 30322; Telephone: 404-785-6330; Fax: 404-785-6266; Email: kkanter@emory.edu

Subjects:

Research Funding:

This study was supported by the National Heart Lung and Blood Institute Grant HL67622 and a grant from Children's Healthcare of Atlanta to Dr. Kanter

Preliminary Clinical Experience with a Bifurcated Y-Graft Fontan Procedure--A Feasibility Study

Tools:

Journal Title:

Journal of Thoracic and Cardiovascular Surgery

Volume:

Volume 144, Number 2

Publisher:

, Pages 383-389

Type of Work:

Article | Post-print: After Peer Review

Abstract:

OBJECTIVE Optimizing flow and diminishing power loss in the Fontan circuit can improve hemodynamic efficiency potentially improving long-term outcomes. Computerized modeling has predicted improved energetics with a Y-graft Fontan. METHODS From August to December, 2010, six consecutive children had a completion Fontan (n=3) or a Fontan revision (n=3) using a bifurcated polytetrafluoroethylene Y-graft (18×9×9 mm in 2, 20×10×10 mm in 4) connecting the inferior vena cava (IVC) to the right and left pulmonary arteries (PAs) with separate graft limbs. Patents were imaged by magnetic resonance imaging (MRI; n-5) or computerized tomography (n=1). Computational fluid dynamics (CFD) assessed Fontan hemodynamics, power loss, and IVC flow splits to the branch PAs. Clinical parameters were compared with 12 patients immediately preceding this series who had a lateral Fontan procedure. RESULTS Despite longer crossclamp and bypass times (not statistically significant), the Y-graft Fontan patients had postoperative courses similar to the conventional Fontan patients. Other than two early readmissions for pleural effusions managed with diuretics, on 6–12 months follow-up (mean 8 months), all six patients have done well. Postoperative flow modeling demonstrated balanced distribution of IVC flow to both PAs with minimal flow disturbance. Improvements in hemodynamics and efficiency were noted when the Y-graft branches were anastomosed distally and aligned tangentially with the branch PAs. CONCLUSIONS This preliminary surgical experience demonstrates clinical feasibility of the bifurcated Y-graft Fontan. CFD shows acceptable hemodynamics with low calculated power losses and balanced distribution of IVC flow to the PAs as long as the branch grafts are anastomosed distally.

Copyright information:

© 2012 The American Association For Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Creative Commons License

Export to EndNote