Outcomes after extracardiac Fontan procedure with a 16-mm polytetrafluoroethylene conduit.

OBJECTIVES: We evaluated the outcomes of patients who underwent extracardiac Fontan circulation procedures (ECFP) and received 16-mm polytetrafluoroethylene conduits. METHODS: From June 1997 to May 2015, among the 408 patients who underwent ECFP, 66 patients (Group S) also received 16-mm polytetrafluoroethylene conduits. To compare this patient cohort with similarly sized patients who received larger conduits, a matched cohort (66 patients, Group L) was selected according to age and body weight. RESULTS: The mean age, body weight and Nakata index at ECFP in Groups S and L were 2.9 +/- 1.2 and 3.1 +/- 1.2 years (P = 0.243), 13.0 +/- 2.4 and 13.0 +/- 2.3 kg (P = 0.101), 175.3 +/- 59.0 and 236.1 +/- 75.1 mm(2)/m(2) (P = 0.005), respectively. The mean follow-up periods for Groups S and L were 7.8 +/- 6.0 and 9.1 +/- 4.9 years (P = 0.150), respectively. The conduit size of Group L was 19.2 +/- 1.4 mm (P < 0.001). There was no significant difference in mortality between the groups (P = 0.109). The freedom from reoperation was 94.0 +/- 3.4% in Group S and 79.3 +/- 5.7% in Group L after 10 years (P = 0.070). Late-occurring morbidities included protein-losing enteropathy (2 in Group S, 4 in Group L; P = 0.491) and thromboembolism (0 in Group S, 4 in Group L; P = 0.206). There was a significant difference in conduit-related events between the groups (1 in Group S, 5 in Group L; P = 0.031). In a paired cohort from the 2 groups including patients who were followed-up for more than 10 years (15 patients from each group), the body mass index was 51.0 +/- 33.2% in Group S and 30.3 +/- 34.2% in Group L. The decreases in the conduit cross-sectional areas for the paired patients in Group S (n = 20) and Group L (n = 20) were 14.9 +/- 19.7% and 24.5 +/- 15.5% (P = 0.076), respectively. Coarse liver parenchyma was detected in 9 of 23 (39.1%) patients from Group S and in 7 of 18 (38.8%) patients from Group L upon ultrasonography. CONCLUSIONS: The 16-mm polytetrafluoroethylene conduit for ECFP showed acceptable outcomes and good haemodynamic status in small-sized patients. According to our results, small patients do not require large conduits to accommodate their growth potential.