Epidural catheterisation for empyema thoracis: Risk of epidural abscess
Journal
European Journal of Cardio-thoracic Surgery
Journal Volume
39
Journal Issue
1
Pages
145-146
Date Issued
2011
Author(s)
Abstract
study has shown that Fontan patients present a general trend for progressive reduction in exercise capacity at follow-up [3].The purpose of our study was to understand if delaying Fontan completion could affect the medium-term results, and we had evidence that delaying Fontan completion beyond 7 years of age was not inferior to completion before 7 years of age.It is important to stress that the choice of delaying Fontan completion was based on individual clinical grounds and applied only to patients who maintain stable values of arterial saturation at follow-up.We clearly agree that postponing Fontan completion to late adolescence or adulthood is inappropriate, as reflected in our practice.On the other hand, the followers of the 'early Fontan completion' advocate that early ventricular unloading might preserve cardiac function and exercise capacity at follow-up.However, no robust evidence exists to support this latter approach.Indeed, the recent study by Shiraishi et al. [4] studied a population very different from ours in terms of underlying ventricular morphology (100% left) and staging strategy (70% primary Fontan completion), and the interpretation of the results of that study have been appropriately criticised elsewhere [5].With improved patient selection and intra-and postoperative care, early completion of Fontan operation, even in 1-year old children, is not a technical challenge anymore.Therefore, we think that the decision on the timing should only be driven by follow-up data.Indeed, if the 'ticking clock' hypothesis was correct, early completion could turn into early failure.Unfortunately, there are no data available yet to demonstrate that early completion translates into improved long-term results.While awaiting such evidence, we suggest that delaying Fontan completion beyond the first few years of life with close follow-up of the candidates does not seem to impact on medium-term outcomes.
SDGs
Type
letter