Right atrioventricular extracardiac conduit as a Fontan modification: late results

Background. The right ventricle, when incorporated in the Fontan circulation, might enlarge and function as a pump to the pulmonary circulation. Experience has shown that over the long-term, this operation can be associated with major difficulties. Methods. The late results, (13 ± 6 years) after right atrioventricular connection as a Fontan modification, were reviewed in 14 patients with tricuspid atresia (11), ventricular septal-defect with small right ventricle (2), and double inlet left ventricle (1) to assess the long-term survival, the right ventricular size, and the need and timing of reoperations. Operations used a valved conduit (7), a valveless Dacron (E.L. Bard, Haverhill, PA) tube (5) and a direct right atrium-right ventricle anastomosis (2). Results. Death occurred in 5 by 8 ± 5 years. Conduit obstruction occurred in 10 by 9 ± 3 years equally in patients with valved (6 of 7) compared to patients with valveless conduits (4 of 5) and irrespective of right ventricular size (3 of 4 with enlarged right ventricle versus 4 of 6 with small ventricle). Patients with direct atrioventricular anastomosis had no obstruction. Reoperation was performed in 9 but failed to relieve the obstruction in 4 because of external compression (4) with or without thrombosis (1). Conclusions. Right atrioventricular connection as a Fontan modification can provide good early palliation, but is a poor long-term solution, as it is associated with a high incidence and difficulties in relieving the obstruction.