Off Pump Valve Replacement Safe and Effective in Select Pediatric Patients

Valve replacement, using an off pump extra-cardiac Fontan procedure, is safe and effective in pediatric patients, according to data presented on Thursday during the Cardiothoracic Techniques and Technologies 2002 meeting in Miami Beach, Florida.

“In selected patients the procedure can be accomplished easily and safely,” Dr. Jonathan J. Drummond-Webb, of Arkansas Children’s Hospital in Little Rock, told Reuters Health. “But,” he cautions, “this should not be tried at all costs…this is a highly selective surgery.”

Of 85 patients undergoing a Fontan procedure since 1992, Dr. Drummond-Webb and colleagues performed extra-cardiac Fontan surgery in 44 patients. Twenty-four of these patients, who were a mean age of 5.9 years and a mean weight of 20.7 kg, underwent off pump extra-cardiac Fontan for diagnoses including tricuspid atresia, single ventricle with pulmonary artery obstruction, pulmonary atresia with intact septum, or single ventricle physiology.

The median postoperative hospital stay was 16 days for the off pump patients, and after 44 months of follow-up, the researchers report no re-operation has been needed in the off pump group.

Complications with the off pump surgery included cyanosis, pleural effusions, and phrenic nerve injury. Dr. Drummond-Webb noted that one patient died of aplastic bronchitis 11 months after surgery.

He pointed out that avoiding cardiopulmonary bypass means avoiding numerous complications associated with bypass surgery. The neurological future of pediatric patients is unknown. “We are trying to avoid potential neurological deficits [in this patient group] by avoiding coronary artery bypass surgery and performing off pump Fontan,” Dr. Drummond-Webb told Reuters Health.

He concludes that off pump extra-cardiac Fontan is safe and effective if done within the strict parameters of the Fontan procedure.