Mid-term outcome of extracardiac Fontan operation using Contegra conduit

BackgroundLimited surgical experience of constructing Fontan circulation using Contegra conduit has raised concerns of high risk of thrombotic occlusion of Fontan circuit.In this study we intended to retrospectively evaluate thrombotic complication and survival of patients undergone extra-cardiac Fontan procedure.MethodsMedical records of all patients who underwent Fontan completion from January 2002 to December 2010 were reviewed. Echocardiographic, catheterization, and peri-operative data were recorded. Outcome of Fontan procedure using Contegra conduit was compared with those constructed with Dacron tube. All patients received anticoagulation using heparin in the immediate postoperative period and later on Coumadin to maintain therapeutic level of INR. The primary outcome was the prevalence of thrombotic complication and the survival in the two groups. Chi-square was used to compare the categorical variables. Independent 2 sample t-test was used to compare the pre-operative and postoperative numerical variables in the two groups and Kaplan meier curve and Log Rank test were generated to compare the time interval of the two primary outcomes of the two groups.ResultsSeventy-six patients underwent Fontan procedure, using Contegra (n=47) and Dacron tube (n=29). The two groups matched with regard to demographic variables, preoperative hemodynamic data, intra-operative and post-operative outcome. Thrombotic complications occurred within the first 30 days in 6/47 (13%) in Contegra and 3/29 (10%) in Dacron group and the difference was not significant (p=0.983). Relative risk of thrombosis in Contegra group was 0.949 (95% CI=0.8–1.3). The mean follow up for the whole group was 87 months. The mean follow up for Contegra group was 70 months and 95 months for the Dacron group but this difference was not significant (p=0.304). Nine patients died: Contegra 7/47, Dacron, 2/28 (p=0.486). Relative risk of dying in Contegra group was 0.909 (95% CI=0.8–1.1).ConclusionThis is the largest series evaluating the outcome of extra-cardiac Fontan procedure using Contegra conduit. Our results suggest that using Contegra conduit does not increase the risk of thrombotic complication or death compared to Fontan completion using Dacron tube

Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study

ObjectiveTo characterize medical and nonmedical reasons for delayed discharge on a general thoracic surgery unit.DesignA prospective observational cohort study.SettingA university-affiliated tertiary care institution.PatientsBetween February 1999 and July 2000, the in-hospital progress of 130 patients who had undergone an elective thoracic surgical procedure was evaluated prospectively. Baseline characteristics (age, sex, comorbid conditions and pulmonary function test results) were documented.Main outcome measuresComplications that delayed the time when the patient was medically ready for discharge. The day the patient was deemed fit for discharge (medically required length of stay) was compared with the actual day of discharge (actual length of stay). [...]impact on medically required length of stay, social factors may also significantly delay discharge