Mid-term follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure

Objective: Extracardiac conduit Fontan procedure (ECFP) using Gore-Tex graft has been performed with increasing frequency for the patients with functional single ventricle. However, lack of growth potential and longevity of the conduit are consistent concerns and main points of criticism of the ECFP. In this study, we investigated the mid-term status of the Gore-Tex graft used in the ECFP by comparingthe internal diameter ofthegraftwiththeinferiorvenacava(IVC)diameter at1monthand5.2yearsaftertheECFP.Methods:Of79 patientswhounderwentECFPusing Gore-TexgraftbetweenNovember 1997andDecember2007,33 patientswhohadcompletedcardiaccatheterization at1 month(21—73days) and 5.2 years (3.3—9.6 years) after the ECFP were included in this study. We measured the internal diameter of the Gore-Tex graft and IVC at both catheterizations retrospectively. Results: The size of the Gore-Tex graft used in the ECFP was 16 mm in 17 patients, 18 mm in 9 patients, and 20 mm in 7 patients. Laminar flow through the conduits was maintained without any stenosis or kinking of the graft in these 33 patients. No intervention or reoperation related to the extracardiac conduit has been required. There were no significant differences in mean cross-sectional area (CSA) of the conduits at 1 month versus 5.2 years after the ECFP for each conduit size, and no significant changes in the conduit-to-IVC CSA ratio (0.98 0.40 vs 0.82 0.21 for 16 mm, 1.09 0.30 vs 0.92 0.33 for 18 mm, and 1.16 0.55 vs 0.94 0.44 for 20 mm conduit). Conclusions:TheconduitCSA andconduit-to-IVCCSA ratioremainedunchangedinsmall calibergrafts downto 16 mm at 5.2yearsafterthe ECFP. However, further investigation is necessary to evaluate the fate of the Gore-Tex graft and late hemodynamics in the patients with small conduits after they achieve full somatic growth. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.