Definitions:
The length of hospital stay was defined as the time between the operation and the discharge of the patient. Re-hospitalization was defined as hospitalization within 30 days after the discharge of the patient postoperativelyfrom the hospital. Prolonged drainage was defined as chest tube duration more than a week. Cardiopulmonary resuscitation (CPR), need forextracorporeal membrane oxygenator (ECMO), atrioventricular(AV) block requiring permanent pacemaker (PM) implantation, diaphragm paralysis, neurological complication (persistent at discharge), acute renal failure (ARF) and unplanned reoperation were considered as MAE (7). Catheter interventions in the postoperative period were defined as reintervention. Hospital mortality was defined as mortality within the hospital or within the first 30 days postoperatively.
Surgical Technique: In our hospital, extracardiac (EC) Fontan procedure has been routinely performedfor end-stage palliation. An intra-extracardiac (IEC)Fontan operationwas performed only when standard extracardiac Fontan was not feasible, typically asin patients with isomerismand unusual systemic and pulmonary venous patterns. Procedures were performedunder normothermic or mild hypothermic cardiopulmonary bypass. Cardioplegic arrest was used only if concomittant intracardiac procedure was required. The pulmonary arteries were reconstructed as necessary, using xenograft pericardium, based on the cardiac catheterization and operative findings. The threshold for pulmonary artery reconstruction was very low.
In our clinic, fenestration has notbeen performed routinely except in high-risk patients (in case of atrioventricular valve regurgitation and those with high PVR, end-diastolic pressure and delayed patients). Four milimetres fenestrations were performed in patients with central venous pressure (CVP) higher than 16 mmHg and transpulmonic gradient (TPG) more than 12 mmHg at the end of the Fontan procedure. In addition, in patients with a CVPvalue between 14-16 mmHg, fenestration was not performed, instead the right atrium and Fontan tube were brought together by a purse stich to be used for opening a fenestration via transcatheter route if required. This region was also marked with radio-opaque pacemaker wires to guide the possible transcatheterintervention (Figure 1-4).