Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?
The results of the Fontan operation depend on initial hemodynamic. In our opinion fenestration in Fontan circuit should not be a routine procedure. Some pharmacological agents reduce pulmonary vascular resistance thus decreasing venous pressure [1]. We agree with the necessity of fenestration after cardiopulmonary bypass in high-risk patients [2]. We believe that Fontan operation with complex concomitant intracardiac procedures and venous pressure higher than 18 mmHg in the postoperative period are indications for fenestration. Given results are based on a perfect surgical and pharmacological strategy and optimal indications to Fontan operation.
