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Early Outcomes Following Extracardiac Fontan Using Exgraft Vs Gore-tex Conduits
Jorge Alberto Monserrate-Marrero, MD, Kei Kobayashi, Annaliese Calzedilla, Veenah Stoll, Carlos Diaz-Castrillon, Laura Seese, Mario Castro-Medina, Luciana Da Fonseca Da Silva, Jose P. Da Silva, Richard Tang, Victor O. Morell.
University of Pittsburgh, Pittsburgh, PA, USA.
Objective(s): ExGraft conduits have been increasingly adopted for extracardiac Fontan completion, but comparative outcomes versus Gore-Tex conduits remain limited. We evaluated early outcomes after extracardiac Fontan using ExGraft vs Gore-Tex conduits.
Methods: We performed a single-institution retrospective cohort study of patients undergoing extracardiac Fontan completion from 2018-2025. Patients were stratified by conduit type. Baseline characteristics, operative variables, Fontan circuit reinterventions, mortality, readmission, and complications were compared. Continuous variables were summarized as median [IQR] and compared using Wilcoxon rank-sum testing; categorical variables were summarized as n (%) and compared using Fisher’s exact test.
Results: Ninety patients were included: 37 (41.1%) Gore-Tex and 53 (58.9%) ExGraft. Overall, the median follow-up was 4.0 years. Baseline demographic and anatomic characteristics were similar between groups. Conduit use differed by era, with ExGraft comprising 30/41 contemporary-era cases (73.2%) compared with 23/49 earlier-era cases (46.9%; p=0.018). The 18-mm conduit was most common in both groups (83.8% vs 60.4%), whereas 16-mm conduits were more frequent with ExGraft (24.5% vs 2.7%; p=0.006). Catheter-based Fontan circuit intervention occurred in 2 Gore-Tex patients and none in ExGraft. Surgical reintervention occurred in 2 Gore-Tex and 1 ExGraft patient.
Conclusions: ExGraft conduits had favorable early outcomes, with low reintervention and complication rates. The potential for expandability over time may offer advantages as the patients grow, but longer follow-up is needed to assess durability and impact.
Baseline Characteristics and Early Outcomes by Fontan Conduit Type| Baseline/Operative Characteristics | Gore-tex (n=37) | ExGraft (n=53) | p-value |
| Age at Fontan, years | 2.7 [2.3-3.4] | 2.8 [2.3-3.2] | 0.964 |
| Catheter-based Fontan circuit intervention | 2 (5.4%) | 0 (0.0%) | 0.166 |
| Surgical Fontan circuit reintervention | 2 (5.4%) | 1 (1.9%) | 0.566 |
| Conduit size distribution, mm | | | |
| 16 | 1 (2.7%) | 13 (24.5%) | 0.018 |
| 18 | 31 (83.8%) | 32 (60.4%) | |
| 19 | 0 (0.0%) | 3 (5.7%) | |
| 20 | 4 (10.8%) | 5 (9.4%) | |
| 22 | 1 (2.7%) | 0 (0.0%) | |
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