Fontan Procedure in Patients with Preoperative Mean Pulmonary Artery
Pressure Over 15 mmHg
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.