Off-Pump “Clamp and Sew” Extracardiac Fontan With a Bifurcated Graft for Heterotaxy With Dextrocardia

This video shows the authors’ technique of off-pump "clamp and sew" extracardiac Fontan completion in heterotaxy and dextrocardia. The patient was a 3-year-old boy who had a right dominant unbalanced complete atrioventricular septal defect with pulmonary atresia and transposition of the great arteries. He had bilateral superior venae cavae with left-sided inferior vena cava and large midline liver. The right hepatic vein entered the right atrium separately, while the left hepatic vein joined the left sided inferior vena cava prior to joining the right atrium. He underwent stage I palliation with a modified Blalock-Taussig shunt as a neonate, followed by stage II palliation with bilateral bidirectional cavopulmonary anastomoses. His preoperative hemodynamics were suitable for Fontan completion.

The procedure was performed via a third-time sternotomy without cardiopulmonary bypass or any venous bypass circuit. A bifurcated graft was used to match the size of both the right hepatic vein and the left inferior vena cava.

The patient tolerated the procedure well and was extubated in the operating room at the end of the procedure. He received no transfusion during his entire hospital stay.

References

1. Bangash SK, Pathan IH, Zaki SB. Total cavopulmonary connection for functionally single ventricle without cardiopulmonary bypass support. J Coll Physicians Surg Pak. 2016 Oct;26(10):855-857.
2. Mainwaring RD, Reddy VM, Hanley FL. Completion of the three-stage Fontan pathway without cardiopulmonary bypass. World J Pediatr Congenit Heart Surg. 2014 Jul;5(3):427-433.

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