Pulmonary Artery Flow Patterns After the Fontan Procedure Are Predictive of Postoperative Complications

• Published in: Journal of cardiothoracic and vascular anesthesia 2009-02, Vol.23 (1), p.54-61
• Main Authors: Leyvi, Galina, MD, Bennett, Henry L., PhD, Wasnick, John D., MD, MPH
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia & Perioperative Care; Child; Child, Preschool; complications after Fontan procedure; Critical Care; Doppler evaluation of pulmonary artery flow; Fontan procedure; Fontan Procedure - adverse effects; Humans; Infant; Monitoring, Intraoperative - methods; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Predictive Value of Tests; Prospective Studies; Pulmonary Artery - physiology; pulmonary artery flow patterns; Pulmonary Circulation - physiology
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2008.06.011

Objective Pulmonary artery (PA) flow reversal has been associated with poor outcome in patients with atriopulmonary (APC) and total cavopulmonary connection (TCPC) lateral tunnel (LT) Fontan modification. The authors studied PA flow after TCPC in relation to the incidence of early Fontan outcome and complications. Design A prospective observational study. Setting A university hospital. Participants Pediatric patients undergoing a Fontan procedure. Intervention Nineteen patients were studied. PA flow was measured by pulse-wave Doppler during the surgery after chest closure. Patients were divided into 2 groups according to patterns of PA flow: group 1, positive (biphasic or continuous flow), and group 2, negative (with flow reversal component). The postoperative complications were recorded. Measurements and Main Results There were no deaths or reoperations for Fontan takedown. Ten patients had positive and 9 had negative flow. There were no differences between groups regarding age, weight, length of procedure, and cardiopulmonary bypass. The chest tube drainage in patients with negative flow was significantly longer than those in the positive-flow group (8.3 ± 7.0 days in the negative-flow group v 2.8 ± 1.7 days in the positive-flow group, p = 0.03). The total number of complications was higher in the negative-flow group compared with the positive-flow group (3.0 ± 1.3 v 1.2 ± 0.6, p = 0.003). The differences between groups in terms of pediatric intensive care unit and/or hospital length of stay did not reach statistical significance, possibly because of the low number of patients. Conclusion PA flow pattern appears to be predictive of the length of postoperative chest tube drainage and the number of postoperative complications.