Preoperative Hemodynamics Impact the Benefit of Fenestration on Fontan Postoperative Length of Stay

Authors

Garick D Hill
Danny T Y Wu
M Eric Ferguson
Saul Flores
Salil Ginde
Kevin D Hill
Michael Johansen
Jane W Newburger
Zhiqian Gao
James F Cnota

Publication Date

3-1-2024

Journal

JACC: Advances

DOI

10.1016/j.jacadv.2024.100846

PMID

38606347

PMCID

PMC11008224

PubMedCentral® Posted Date

2-5-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Glenn pressure, hypoplastic left heart syndrome, single ventricle

Abstract

BACKGROUND: Utilization of Fontan fenestration varies considerably by center.

OBJECTIVES: Using a multicenter Pediatric Heart Network dataset linking surgical and preoperative hemodynamic variables, the authors evaluated factors associated with use of Fontan fenestration and the impact of fenestration on post-Fontan length of stay (LOS).

METHODS: Patients 2 to 6 years old at Fontan surgery from 2010 to 2020 with catheterizationeffect.

RESULTS: Fenestration was used in 465 of 702 patients (66.2%). Placement of a fenestration was associated with center (range 27%-93% use,

CONCLUSIONS: There is wide center variability in use of Fontan fenestration that is not explained by preoperative hemodynamics. Fenestration is independently associated with shorter LOS, and those with mPAP ≥13 mm Hg at pre-Fontan catheterization benefit the most. We propose this threshold as minimal criteria for fenestration.