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OBJECTIVE:
Extracardiac off-pump is reported to result in better early hemodynamics and shorter mechanical ventilation periods. We present the technical video of extracardiac off-pump Fontan in a 5 year-old-girl with single ventricle and dextrocardia
METHODS:
Following resternotomy, all mediastinal structures including prior bidirectional Glenn anastomosis, bilateral pulmonary arteries and inferior vena cava (IVC) as inferior as hepatic veins are extensively freed of adhesions from prior operation. Left pulmonary artery is used for ePTFE conduit anastomosis superiorly due to dextrocardia. Technically, midline position of the IVC allowed for a satisfactory configuration of the conduit as the right-sided Glenn anastomosis perfused the right lung allowing oxygenation during superior anastomosis. Another technical cornerstone is to elevate the heart without disturbing the atrioventricular loading. A “Y-shaped” passive venous drainage system is used between distal IVC and the atrium in trendelenburg position followed by end-to-end anastomosis of the conduit to IVC.
RESULTS:
For extracardiac Fontan, correct orientation of the conduit is a major determinant of the outcome; an intact posterior caval wall during inferior anastomosis is the cornerstone. Strong cooperation with the anesthesiology team is important for optimal loading and inotropic requirements during the procedure
CONCLUSIONS:
Patients with heterotaxy syndromes constitute a very difficult group of patients, particularly those with right isomerism.ECFP technique, in addition to well-known above-mentioned advantages, allowed a practical and quicker approach for Fontan completion as venous cannulation and control of the Glenn anastomosis would have otherwise been cumbersome for the surgeon.This technique of ECFP for Fontan completion in patients with dextrocardia is an acceptable option in selected patients