A Defined Management Strategy Improves Early Outcomes After the Fontan Procedure: The Portland Protocol Rachel E. Sunstrom, PA-C, Ashok Muralidaran,

Slides:

Advertisements

Similar presentations

Results of Coronary Artery Endarterectomy and Coronary Artery Bypass Grafting for Diffuse Coronary Artery Disease Srikrishna Sirivella, MD, Isaac Gielchinsky,

Advertisements

Definitive or Preoperative Chemoradiation Therapy for Esophageal Cancer: Patterns of Care and Survival Outcomes Meng S. Shao, MD, Andrew T. Wong, MD,

Takeshi Shinkawa, MD, Petros V. Anagnostopoulos, MD, Natalie C

Niv Ad, MD, Linda Henry, PhD, RN, Deborah J. Shuman, BS, Sari D

Outcomes of Reintervention on the Autograft After Ross Procedure

Phillips B. Harrington, MD, William W. McAlexander, MD, Ayesha S

Peter Lukac, MD, Vibeke E. Hjortdal, MD, PhD, Anders K

Modified Starnes Procedure in a Neonate With Severe Tricuspid Regurgitation Ashok Muralidaran, MD, Richard W. Kim, MD, Gary S. Kopf, MD, Nicholas P. Pietris,

Lisa M. Brown, MD, MAS, David T. Cooke, MD, Elizabeth A. David, MD

Video-Assisted Thoracoscopic Left Ventricular Pacing in Patients With and Without Previous Sternotomy Katharine E. Nelson, MBBS, MRCP, Matthew G.D. Bates,

Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery Farkas B. Vánky, MD, PhD, Erik.

Early Outcomes of Primary Sutureless Repair of the Pulmonary Veins

Dhaval Chauhan, MD, Alexis K

Michael E. Halkos, MD, Patrick Kilgo, MS, Omar M

Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations Giovanni Filardo, PhD, MPH, Paul.

Vena Cava Filter Fracture With Migration to the Pulmonary Artery

Robert E. Merritt, MD, Richard I. Whyte, MD, Nicole T

The Impact of Peripheral Vascular Disease on Long-Term Survival After Coronary Artery Bypass Graft Surgery Danny Chu, MD, Faisal G. Bakaeen, MD, Xing.

Influence of Pulmonary Hypertension on Patients With Idiopathic Pulmonary Fibrosis Awaiting Lung Transplantation Don Hayes, MD, MS, Sylvester M. Black,

Lindsay C.H. John, MD, FRCS The Annals of Thoracic Surgery

Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Shunji Sano, MD, Shu-Chien Huang, MD, Shingo Kasahara,

Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer Robert E. Merritt, MD, Chuong D. Hoang, MD,

An Easy Modification of Tube Graft Interposition During Fenestration in Borderline Fontan Circulation C. Tayyar Sarioglu, MD, Emrah Sisli, MD, Yusuf.

Chronic Atrial Fibrillation Is Associated With Reduced Survival After Aortic and Double Valve Replacement Richard Schulenberg, MD, Polychronis Antonitsis,

Aortic Valve Replacement Improves Survival in Severe Aortic Stenosis Associated With Severe Pulmonary Hypertension Ramdas G. Pai, MD, Padmini Varadarajan,

Mediastinal Fibrosis of the Pulmonary Artery Secondary to Tuberculosis

Samuel P. Morreau, David A. Haydock, MBChB, FRACS

Total Arterial Revascularization: A Superior Strategy for Diabetic Patients Who Require Coronary Surgery James Tatoulis, MD, FRACS, Rochelle Wynne, PhD,

Ichiro Kashima, MD, Yoshihiko Mochizuki, MD, Masahiko Okamoto, MD

James D. St. Louis, MD The Annals of Thoracic Surgery

Age-Dependent Gender Disparities in Post Lung Transplant Survival Among Patients With Idiopathic Pulmonary Fibrosis Shahid I. Sheikh, MD, Don Hayes,

Elliot Wakeam, MD, MPH, James P. Byrne, MD, Gail E

Bronchoscopic Management of Patients With Symptomatic Airway Stenosis and Prognostic Factors for Survival Lawrence Okiror, MBChB, Li Jiang, MBChB, Nicola.

Felix G. Fernandez, MD, Onkar Khullar, MD, Seth D

Sameh M. Said, MD, Harold M. Burkhart, MD, Joseph A

Aortic Valve Replacement for Patients With Severe Aortic Stenosis: Risk Factors and Their Impact on 30-Month Mortality Edward L. Hannan, PhD, Zaza Samadashvili,

Aorto-Left Ventricular Tunnel: An Alternative Surgical Approach

Embolized Methyl Methacrylate to the Right Atrium After Kyphoplasty

Prospective Assessment of the CryoMaze Procedure With Continuous Outpatient Telemetry in 136 Patients A. Claire Watkins, MD, Cindi A. Young, BSN, Mehrdad.

Editorial Board, January 2010

Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients Koichi Toda, MD, Kazuhiro Taniguchi, MD, Takafumi Masai, MD, Toshiki.

Extended Pneumonectomy With Partial Resection of the Left Atrium, Without Cardiopulmonary Bypass, for Lung Cancer Lorenzo Spaggiari, MD, PhD, Massimiliano.

Role of transvalvular gradient in outcome from valve replacement for aortic stenosis Arjuna Weerasinghe, FRCS, PhD, Merangani Yusuf, FRCS, Thanos Athanasiou,

Outcome of Patients With Aortic Stenosis Referred to a Multidisciplinary Meeting for Transcatheter Valve Marjan Jahangiri, FRCS, Jean Claude Laborde,

Patrick O. Myers, MD The Annals of Thoracic Surgery

Adhering to Quality Measures in Esophagectomy Is Associated With Improved Survival in All Stages of Esophageal Cancer Pamela Samson, MD, MPHS, Varun.

Very Prolonged Stay in the Intensive Care Unit After Cardiac Operations: Early Results and Late Survival Shuli Silberman, MD, Daniel Bitran, MD, Daniel.

Andrew L. Mesher, MD, Joshua L. Hermsen, MD, Agustin E

Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction Waleed A. Ahmed, MD, Phillip J. Tully, BHSc(Hons),

Matthew C. Henn, MD, Christopher P. Lawrance, MD, Laurie A

Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population Christian McNeely, MD, Stephen.

Left Ventricular Reconstruction Benefits Patients With Dilated Ischemic Cardiomyopathy Atsushi Yamaguchi, MD, Hideo Adachi, MD, Koji Kawahito, MD, Seiichiro.

Prolonged Intensive Care Unit Stay in Cardiac Surgery: Risk Factors and Long-Term- Survival Ortrud Vargas Hein, MD, Jürgen Birnbaum, MD, Klaus Wernecke,

Invited Commentary The Annals of Thoracic Surgery

Dual Inferior Vena Cava: Two Inferior Vena Cava Filters

Superior Vena Cava to Pulmonary Artery Anastomosis as an Adjunct to Biventricular Repair: 38-Year Follow-Up Siho Kim, MD, Osman Al-Radi, MD, Mark K.

Successful Conversion of TandemHeart Left Ventricular Assist Device to Right Ventricular Assist Device After Implantation of a HeartMate XVE Masami Takagaki,

Cardiac Myxomas: A 50-Year Experience With Resection and Analysis of Risk Factors for Recurrence Ishan K. Shah, MD, Joseph A. Dearani, MD, Richard C.

Effect of Formalin Fixation on Tumor Size Determination in Stage I Non-Small Cell Lung Cancer Po-Kuei Hsu, MD, Hsu-Chih Huang, MD, Chih-Cheng Hsieh,

Totally Extracardiac Maze Procedure Performed on the Beating Heart

Patient-Prosthesis Mismatch After Mitral Valve Replacement: A Propensity Score Analysis Ho Young Hwang, MD, PhD, Yong Han Kim, MD, Kyung-Hwan Kim, MD,

Early and Midterm Outcomes for Tricuspid Valve Surgery After Left-Sided Valve Surgery Choung Kyu Park, MD, Pyo Won Park, MD, Kiick Sung, MD, Young Tak.

Impact of Cardiothoracic Resident Turnover on Mortality After Cardiac Surgery: A Dynamic Human Factor Jeffrey H. Shuhaiber, MD, Kimberley Goldsmith,

Yangfeng Tang, MD, Zilin Liao, MD, Lin Han, MD, Zhiyun Xu, MD

Temporary Fenestration Using Venoatrial Extracorporeal Membrane Oxygenation After the Fontan Operation Yun Hee Chang, MD, Hyungtae Kim, MD, Si Chan Sung,

Survival and Outcomes of Pulmonary Resection for Non-Small Cell Lung Cancer in the Elderly: A Nested Case-Control Study Robert J. Cerfolio, MD, Ayesha.

Dumbor L. Ngaage, MD, FRCS (C-Th), Michael E. Cowen, FRCS

Ravi K. Ghanta, MD, Prem S. Shekar, MD, Siobhan McGurk, BS, Donna M

The Impact of New Technology on Cardiothoracic Surgical Practice

How I Teach Hemi-Arch Replacement

Presentation transcript:

A Defined Management Strategy Improves Early Outcomes After the Fontan Procedure: The Portland Protocol Rachel E. Sunstrom, PA-C, Ashok Muralidaran, MD, Rabin Gerrah, MD, Richard D. Reed, PA-C, Milon K. Good, MPH, Laurie R. Armsby, MD, Andrew J. Rekito, MS, M. Mujeeb Zubair, MD, Stephen M. Langley, MD, FRCS (CTh) The Annals of Thoracic Surgery Volume 99, Issue 1, Pages 148-155 (January 2015) DOI: 10.1016/j.athoracsur.2014.06.121 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 During creation of fenestration, the right atrium cannula is replaced with a cardiotomy sucker. The hole in the graft is created approximately 2/3 the distance from the inferior vena cava to the pulmonary artery. The atriotomy is created on the lateral smooth-walled portion of the atrium. (Created by Andy Rekito, MS, and reproduced with permission from Oregon Health and Science University.) The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The sutures include full-thickness on the atrial side and partial-thickness on the graft, at a perimeter of at least 3 to 4 mm around the punch hole. (Created by Andy Rekito, MS, and reproduced with permission from Oregon Health and Science University.) The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 A running suture is continued around the circumference of the fenestration, bringing the atrium and graft together. (Created by Andy Rekito, MS, and reproduced with permission from Oregon Health and Science University.) The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Completed “sutureless” fenestration. (Created by Andy Rekito, MS, and reproduced with permission from Oregon Health and Science University.) The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Cardiac catheterization demonstrating a patent fenestration 8 months after Fontan and (B) after device occlusion of fenestration. The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Kaplan-Meier survival curves (dotted line) and Cox proportional hazard regression (solid line) for chest tube days (left) and hospital length of stay (right). Kaplan-Meier analysis demonstrates chest tube duration and hospital length of stay are shortened for those in group B relative to group A (p < 0.001 and p = 0.033, respectively; log-rank test). The Annals of Thoracic Surgery 2015 99, 148-155DOI: (10.1016/j.athoracsur.2014.06.121) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions