Towards the optimal Fontan operation: a single-institution experience

Many groups, including ours, have played a more or less significant role in the development and evolution of the Fontan operation that has taken place over the past four decades. This is a brief review of the contributions developed by our institution. Contributions to clinical and technical areas include: development of the ventricular exclusion concept; promoting the staged approach to the Fontan operation by bidirectional cavopulmonary anastomosis with or without a modified Damus-Kaye-Stansel anastomosis; endorsement of the total extracardiac cavopulmonary connection; a rational approach to the management of systemic venous aberrances in single-ventricle patients; and criteria for transition to heart transplantation. Contributions to computational fluid dynamics include: investigation of the best spatial arrangement for the total extracardiac cavopulmonary anastomosis and identification of the so-called 'beneficial vortex'; studies on the effect of unbalanced pulmonary resistances on the hydrodynamic performance of the total extracardiac cavopulmonary connection; and a rationale for the management of systemic venous anomalies in single-ventricle patients.