ABSTRACT
Background : Several factors affect the long-term outcome of
Fontan procedure, but a high pulmonary artery pressure is still one of
the most important limitation for proceeding to a Fontan circulation.
Herein, we present our experience in Fontan patients with high
preoperative pulmonary artery pressures.
Methods : A retrospective analysis was performed in order to
evaluate Fontan patients with a preoperative pulmonary artery pressure
> 15 mmHg between 2009 and 2020. Sixteen patients were
operated on with a mean preoperative pulmonary artery pressure of 17.5 ±
2.1 mmHg.
Results: Mean age at the time of Fontan procedure was 7.8 ± 5.6
years. All of the patients had stage II cavopulmonary anastomosis prior
to Fontan completion, with a mean interstage period of 4 ± 2.6 years.
Fontan completion was achieved with a polytetrafluorethylene(PTFE) tubular conduit, two of which were intra-extracardiac.
Fenestration was performed in 4 (25%) cases. Postoperative pulmonary
artery pressures and arterial oxygen saturation levels were 11.2 ± 2.8
mmHg and 97.8 ± 2, respectively. Mean duration of pleural drainage was
3.9 ± 5.3 days. Any morbidity and mortality were not encountered during
a mean follow up period of 4.8 ± 7.7 years.
Conclusions: The mid-term results of stage III Fontan
completion in patients with pulmonary artery >15 mmHg are
encouraging. Pulmonary vascular resistance, not only pulmonary artery
pressure may help to identify high risk patients before Fontan
completion.