Cavopulmonary Assist: (Em)powering the Univentricular Fontan Circulation

Mark Rodefeld, Steven H. Frankel, Guruprasad A. Giridharan

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Since the Fontan/Kreutzer procedure was introduced, evolutionary clinical advances via a staged surgical reconstructive approach have markedly improved outcomes for patients with functional single ventricle. However, significant challenges remain. Early stage mortality risk seems impenetrable. Serious morbidities - construed as immutable consequences of palliation - have hardly been addressed. Late functional status is increasingly linked to pathophysiologic consequences of prior staged procedures. As more single-ventricle patients survive into adulthood, Fontan failure is emerging as an intractable problem for which there is no targeted therapy. Incremental solutions to address these ongoing problems have not had a measurable impact. Therefore, a fundamental reconsideration of the overall approach is reasonable and warranted. The ability to provide a modest pressure boost (2 to 6 mmHg) to existing blood flow at the total cavopulmonary connection can effectively restore more stable biventricular status. This would impact not only treatment of late Fontan failure, but also facilitate early surgical repair. A realistic means to provide such a pressure boost has never been apparent. Recent advances are beginning to unravel the unique challenges that must be addressed to realize this goal, with promise to open single-ventricle palliation to new therapeutic vistas.

Original languageEnglish
Pages (from-to)45-54
Number of pages10
JournalPediatric Cardiac Surgery Annual
Volume14
Issue number1
DOIs
StatePublished - 2011

Fingerprint

Fontan Procedure
Pressure
Therapeutics
Morbidity
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Cavopulmonary Assist : (Em)powering the Univentricular Fontan Circulation. / Rodefeld, Mark; Frankel, Steven H.; Giridharan, Guruprasad A.

In: Pediatric Cardiac Surgery Annual, Vol. 14, No. 1, 2011, p. 45-54.

Research output: Contribution to journalArticle

Rodefeld, Mark ; Frankel, Steven H. ; Giridharan, Guruprasad A. / Cavopulmonary Assist : (Em)powering the Univentricular Fontan Circulation. In: Pediatric Cardiac Surgery Annual. 2011 ; Vol. 14, No. 1. pp. 45-54.
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