Extracardiac Fontan With Direct Inferior Vena Cava To Main Pulmonary Artery Connection Sachin Talwar1, Bhavya Talwar2. 1All India Institute of Medical Sciences, New Delhi, India, 2Baptist Memorial Hospital, Oxford, MS, USA.
IntroductionVarious extracardiac total cavopulmonary connection (TCPC) designs using prosthetic conduits remain fraught with limitations including thromboembolic risk, intimal peel formation, lack of somatic growth potential, and the need for lifelong anticoagulation and future revisions. The autologous extracardiac technique addresses these limitations by constructing the IVC-to-Pulmonary Artery pathway from native tissue, preserving growth potential and eliminating prosthetic material from the low-pressure Fontan circuit. This video demonstrates a completely autologous, extracardiac Fontan with direct IVC-to-MPA connection in an appropriately selected patient. DescriptionA six-year-old boy with double outlet right ventricle, unroutable ventricular septal defect, severe pulmonary stenosis, and malposed great arteries with a rightward and posterior MPA underwent a primary Fontan operation. Favorable hemodynamics (mean PA pressure 12 mmHg) and adequate MPA length permitted an this approach. Sequential bilateral bidirectional Glenn anastomoses were performed first. The MPA was then divided, the proximal stump oversewn incorporating the pulmonary valve leaflets, and the IVC transected and anastomosed directly to the distal MPA stump using continuous 5-0 polypropylene suture. The patient was extubated on the operating table with Fontan pressures of 14–16 mmHg and oxygen saturation of 98% on room air. Postoperative CT angiography confirmed laminar flow throughout the Fontan circuit. Tilldate,we have performed six such operations: two of these were off CPB. ConclusionsThis technique achieves a completely autologous TCPC with growth potential, elimination of prosthetic material, and balanced pulmonary blood flow distribution via the MPA connection. Patient selection - particularly adequate MPA length and favorable anatomy is critical for successful application.
