The outcome of extracardiac lateral tunnel total cavopulmonary connection with growing conduit using expanded polytetrafluoroethylene graft.

OBJECTIVES

We sought to examine long-term results of the total cavopulmonary connection with an extracardiac lateral tunnel using expanded polytetrafluoroethylene graft and the outside of right atrial wall, with special attention to angiographic evaluation of serial changes of the tunnel geometry.

METHODS

Of 113 patients subjected to the Fontan operation between April 2003 and April 2022, 65 patients who opted for the extracardiac lateral tunnel technique were retrospectively analyzed. Of these, 35 patients who had at least two postoperative catheterizations (mean 0.7 ± 0.4 and 6.6 ± 3.5 years post-op) were analyzed for changes in tunnel diameter.

RESULTS

There was one case (1.5%) of 30-day death, and three late deaths. The cumulative survival rate at 14 years after the surgery was 91.2%. There was one case (1.5%) which required conversion to total cavopulmonary connection with an extracardiac conduit. Angiographically, Fontan route diameter increased significantly at both the level of inferior vena cava anastomosis (11.0 ± 2.4 to 14.9 ± 3.4 mm, P < 0.001), the middle level of Fontan route (11.0 ± 2.5 to 12.9 ± 3.2 mm, P < 0.001), and the level of pulmonary artery anastomosis (10.0 ± 2.5 to 13.6 ± 4.9 mm, P < 0.001), whereas the diameter indexed to the normal inferior vena cava remained over 100%.

CONCLUSIONS

Long-term results of the Fontan operation with extracardiac lateral tunnel using half cut expanded polytetrafluoroethylene graft and outside of the right atrium were favorable. Proportional increase of conduit size was demonstrated, suggesting a potential of the conduit to grow and that the growth might correlate with somatic growth.