J CARDIOVASC SURG 2006;47:699-704 Extracardiac Fontan operation without cardiopulmonary bypass E. TIRELI 1 , M. UGURLUCAN 1 , M. BASARAN 1 , E. KAFALI 1 , B. HARMANDAR 1 , O. A. SAYIN 1 , Z. SUNGUR 2 , E. DAYIOGLU 1 Aim. The avoidance of cardiopulmonary bypass and aor- tic cross-clamping in patients possessing single ven- tricular physiology has potential advantages including preservation of ventricular and pulmonary functions; early extubation, decreased incidence of pleural effu- sions and decreased requirement of inotropic agents and blood products. In this study, we assessed the post- operative outcome of patients who have undergone extracardiac Fontan operation performed without car- diopulmonary bypass. Methods. Between March 1999 and August 2002, 10 con- secutive patients (6 males and 4 females) underwent extracardiac Fontan operation without cardiopulmonary bypass. The age of patients ranged between 1.5 to 12 (5.2±3.1) years. All the patients requiring any intracar- diac intervention were excluded from the study. Previous operations of the patients were modified Blalock-Taussig shunt procedure in 3 patients, bidirectional cavopul- monary shunt operation in 2 patients and pulmonary arterial banding in 1 patient. All operations were per- formed without cardiopulmonary bypass. Bidirectional cavopulmonary anastomosis was performed by using a transient external shunt constructed between the supe- rior vena cava and right atrium. An appropriate sized tube graft was anastomozed to the inferior surface of right pulmonary artery. Finally, inferior vena cava to tube graft anastomosis was performed with the aid of another external shunt constructed between inferior vena cava and right atrium. During the procedure cen- tral venous pressure, blood pressure and arterial oxygen saturation levels were continuously monitored and recorded. Results. The mean intraoperative Fontan pressure was 16.1±2.75 mmHg. Intraoperative fenestration was required in 4 patients with a Fontan pressure above 18 mmHg. There were no intra and postoperative deaths. Three patients required mild doses of inotropic sup- port during the postoperative period. All patients were 1 Department of Cardiovascular Surgery Istanbul Medical Faculty Istanbul University, Istanbul, Turkey 2 Department of Anesthesiology Istanbul Medical Faculty Istanbul University, Istanbul, Turkey weaned off mechanical ventilation within 24 h. The mean arterial oxygen saturation raised from 74.5±4.2% to 93.5±2%. Arterial oxygen saturation was 95±0.6% in 6 patients without fenestration and 91.2±0.5% in 4 patients with fenestration (P=0.001). All patients were in sinus rhythm postoperatively. Only 2 patients required blood transfusion. Two patients suffered from prolonged pleural effusion (more than 7 days). The mean intensive care unit and hospital stay periods were 3.3±1.5 and 15.4±5.3 days, respectively. Conclusions. The extracardiac Fontan operation per- formed without cardiopulmonary bypass provides good results in short and midterm follow-up periods with improved postoperative hemodynamics. KEY WORDS: Cardiopulmonary bypass - Heart ventricle - Fontan procedure - Anastomosis, surgical. S ince the first description of Fontan operation in 1971, numerous procedures have been defined for the establishment of total cavopulmonary con- nection in patients with univentricular heart physiol- ogy. Previous approaches included cavopulmonary connections by either intra-atrial rerouting using a baffle or intra-atrial grafting with a Gore-Tex tube. Although these procedures seem to be useful in patients requiring an intracardiac intervention, post- operative tendency for systemic venous hypertension and long-term arrhytmogenic effects directed sur- geons to perform total cavopulmonary connection by using an extracardiac conduit. 1 The most striking Address reprint requests to: E. Tireli, MD, Istanbul University Istanbul Medical Faculty, Department of Cardiovascular Surgery, 34390 Capa/Fatih, Istanbul, Turkey. E-mail: emintireli@yahoo.com Vol. 47 - No. 6 THE JOURNAL OF CARDIOVASCULAR SURGERY 699