Title : Outcomes of fenestrated versus non-fenestrated in fontan procedure: A systemic review and meta-analysis
Abstract:
Introduction: Numerous investigations examining fenestration in the Fontan procedure have presented inconsistent findings regarding its effectiveness in improving surgical outcomes. The objective of this meta -analysis is to contrast the early results of fenestrated versus non-fenestrated Fontan procedures.
Method: Literature search was performed using PubMed, Science Direct and Research Gate for obtaining studies comparing Fenestrated and Non-Fenestrated in Fontan Procedure, published between 1992 and 2022. The primary outcome was overall mortality. Secondary outcomes included CPB time, post-operative oxygen saturation, prolonged pleural effusion, ICU stays, hospital stay, fontan failure, and survival rate.
Results: There was a significant difference in terms of cardiopulmonary bypass (CPB) time between both groups (MD, 12.66; 95% CI, [2.87, 22.46]; p = 0.01, I2 = 36%). Significant difference was also observed for post-operative oxygen saturation between the 2 groups (MD, -3.46; 95% CI, [-5.96, 0.96]; p = 0.007, I2 = 89%). Analysis for the outcome prolonged pleural effusion revealed significant difference between two groups (OR, 0.47, 95% CI, [0.24, 0.93]; p = 0.03, I2 = 84%; Fig. 4). Analysis of ICU stay did not show a significant difference between 2 groups (MD, -0.51; 95% CI, [-0.51, 0.68]; p = 0.77, I2 = 45%). A trend of lower hospital length of stay occurrence was observed in the Fenestrated group, however no significant difference was observed (MD, -1.30, 95% CI, [-3.79, 1.18]; p = 0.05, I2 = 0%). Similar finding was revealed in term of fontan failure (OR, 0.69, 95% CI, [0.42, 1.13]; p = 0.14, I2 = 60%). Analysis of Mortality did not show a significant difference between 2 groups (OR, 1.13, 95% CI, [0.55, 2.31]; p = 0.74, I2 = 31%). Similar findings also found in Survival Rate where there was no difference between 2 groups. (OR, 1.04, 95% CI, [0.84,1.30]; p = 0.70, I2 = 0%).
Conclusion: CPB time was found longer in fenestrated group compared to non-fenestrated group. Post-operative oxygen saturation was found higher in non-fenestrated group, whereas prolonged pleural effusion was found in non-fenestrated group. There was no significant difference in terms of ICU stays, hospital stays, fontan failure, mortality and survival rate.
Keywords: Fontan Procedure; Fenestrated; Non-Fenestrated; Outcomes.
Audience Take Away:
The presentation would provide a comprehensive overview of the procedural outcomes about the early results of fenestrated versus non-fenestrated Fontan procedures, shedding light on the comparative effectiveness of these approaches. Here are the specific learning points and benefits the audience can expect:
- Clinical Decision-Making:
The presentation will enable surgeons and clinicians to make more informed decisions regarding the selection of fenestrated or non-fenestrated Fontan procedures based on detailed comparative outcomes like CPB time, post-operative oxygen saturation, and pleural effusion - Research and Educational Impact:
The findings serve as a valuable resource for further research into Fontan procedures and provide a solid educational foundation for teaching medical students and residents about evidence-based practices in pediatric cardiac surgery - Improved Patient Outcomes:
By providing evidence-based insights into procedural outcomes, the research helps in refining surgical techniques and patient management strategies, ultimately aiming to improve patient recovery and procedure effectiveness - Interdisciplinary Collaboration and Policy Formulation:
Encourages collaboration between different medical specialists and helps healthcare administrators in formulating policies or guidelines that standardize care processes, enhancing overall healthcare delivery in pediatric cardiac surgery
