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Peer-reviewedCC BY-NC-NDJTCVS open

Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience.

  • Emma Bergonzoni1,2
  • Irene Cao1,2
  • Luca Vedovelli3
  • Mark Hazekamp4
  • Jürgen Hörer5
  • Eleftherios M Protopapas6
  • Masamichi Ono5
  • Eva Sames-Dolzer7
  • Gregor Gierlinger7
  • Friso M Rijnberg4
  • Lorenzo Galletti8
  • Gianfranco Butera8
29 more authors
  • Bart Meyns9
  • Joeri Van Puyvelde9
  • Lliya Yemets10
  • Elshad Bairamov10
  • Andrzey Kansy11
  • Matej Nosal12
  • Marien Lenoir13
  • Gaetano Gargiulo14
  • Emanuela Angeli14
  • Thomas Martens15
  • Thierry Bove15
  • Carlo Pace Napoleone16
  • Mauro Lo Rito17
  • Alessandro Giamberti17
  • Konstantinos Dimopoulos18
  • Claudia Montanaro19
  • Stefano Marianeschi20
  • Alvaro Gonzalez Rocafort21
  • Biagio Castaldi22
  • Dario Gregori3
  • Giovanni Di Salvo22
  • Giovanni Meliota23
  • Gabriele Scalzo24
  • Giuseppe Scrascia25
  • Guido Michielon26
  • Vladimiro Vida1
  • George Sarris6
  • Andrew Constantine1,8,27
  • Massimo A Padalino1,25
27 affiliations
  1. 1Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
  2. 2Pediatric and Congenital Heart Surgery Department, Monaldi Hospital, Napoli, Italy.
  3. 3Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy.
  4. 4Leiden University Medical Center (LUMC), Leiden, The Netherlands.
  5. 5Division of Congenital and Pediatric Heart Surgery, Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Munich, Munich, Germany.
  6. 6Department for Pediatric and Congenital Heart Surgery, Mitera Children's Hospital, Athens, Greece.
  7. 7Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz, Austria.
  8. 8Department of Cardiac Surgery, Cardiology and Heart Lung Transplant, Bambino Gesù Children's, Hospital IRCCS, Rome, Italy.
  9. 9Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
  10. 10Ukrainian Children's Cardiac Center, Kiev, Ukraine.
  11. 11Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland.
  12. 12National Institute of Cardio-Vascular Diseases, Childrens Heart Center, Bratislava, Slovakia.
  13. 13Department of Congenital Heart Surgery, La Timone Children Hospital, Marseille, France.
  14. 14Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of CardioThoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy.
  15. 15Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium.
  16. 16Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy.
  17. 17Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
  18. 18Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust: Royal Brompton and Harefield Hospitals, London, United Kingdom.
  19. 19Adult Congenital Heart Disease, Bambino Gesù Hospital, Rome, Italy.
  20. 20Congenital Cardiac Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  21. 21Pediatric Cardiac Surgery and Adult Congenital Heart Disease Service, Alianza Estratégica Hospital Universitario La Paz-Hospital Universitario Ramón y Cajal, Madrid, Spain.
  22. 22Pediatric Cardiology Unit, Department of Woman and Child's Health, University of Padova, Padova, Italy.
  23. 23Pediatric Cardiology Unit, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
  24. 24Pediatric Cardiac Surgery Unit, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
  25. 25Congenital Cardiac Surgery, Department of Precision and Regenerative Medicine and Jonian Area, University of Bari Aldo Moro, Bari, Italy.
  26. 26Congenital Heart Surgery and Heart Centre, Gaslini Children's Hospital, Genoa, Italy.
  27. 27Department of Cardiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NSH Foundation Trust, Birmingham, United Kingdom.
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Abstract

Objective

The Fontan procedure is a crucial surgical intervention for single-ventricle physiology, with the extracardiac conduit (ECC) and lateral tunnel (LT) techniques being the predominant approaches. This study aimed to compare early and late clinical outcomes of ECC and LT, using inverse probability of treatment weighting (IPTW) to ensure robust assessments.Methods

A retrospective analysis of 3300 patients from the EUROFONTAN registry was conducted, with data collected from 21 European centers. The cohort included 3010 patients who underwent the ECC technique and 290 patients who underwent the LT technique. IPTW was used to balance baseline characteristics. Primary outcomes were early and late mortality, Fontan failure, and adverse events. Secondary outcomes included postoperative complications and nonsurgical adverse events.Results

Propensity-matched analysis showed significantly better outcomes for ECC. Early mortality was lower for ECC (1.2% vs 3.9%, P = .003), whereas late mortality at 20-year follow-up was 8.6% in LT versus 3.2% in ECC after IPTW (P = .003). Patients who underwent the ECC technique experienced fewer postoperative complications (47% vs 66%, P = .025) and less frequent Fontan failure (12% vs 19%, P = .032). Kidney-related events were more frequent in patients who underwent the LT technique (3% vs 0.6%, P = .004). The development of arrhythmia initially appeared greater in the LT group but equalized after matching. Long-term complications, such as protein-losing enteropathy and hepatic issues, showed no significant differences.Conclusions

ECC was associated with better early and intermediate outcomes than LT in this multicenter European registry. However, surgical era and hospital center explain a substantial part of the observed difference. Continued long-term surveillance of the Fontan pathway is essential to optimize lifelong outcomes.

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Cite

BibTeXRIS
BibTeX
@article{bergonzoni2026extracardiac,
  title = {{Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience.}},
  author = {Emma Bergonzoni and Irene Cao and Luca Vedovelli and Mark Hazekamp and Jürgen Hörer and Eleftherios M Protopapas and Masamichi Ono and Eva Sames-Dolzer and Gregor Gierlinger and Friso M Rijnberg and Lorenzo Galletti and Gianfranco Butera and Bart Meyns and Joeri Van Puyvelde and Lliya Yemets and Elshad Bairamov and Andrzey Kansy and Matej Nosal and Marien Lenoir and Gaetano Gargiulo and Emanuela Angeli and Thomas Martens and Thierry Bove and Carlo Pace Napoleone and Mauro Lo Rito and Alessandro Giamberti and Konstantinos Dimopoulos and Claudia Montanaro and Stefano Marianeschi and Alvaro Gonzalez Rocafort and Biagio Castaldi and Dario Gregori and Giovanni Di Salvo and Giovanni Meliota and Gabriele Scalzo and Giuseppe Scrascia and Guido Michielon and Vladimiro Vida and George Sarris and Andrew Constantine and Massimo A Padalino},
  journal = {JTCVS open},
  year = {2026},
  month = jul,
  doi = {10.1016/j.xjon.2026.101970},
  url = {https://europepmc.org/article/MED/42948481},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Extracardiac conduit versus lateral tunnel: Exploring the optimal surgical approach in the EUROFONTAN experience.
AU  - Emma Bergonzoni
AU  - Irene Cao
AU  - Luca Vedovelli
AU  - Mark Hazekamp
AU  - Jürgen Hörer
AU  - Eleftherios M Protopapas
AU  - Masamichi Ono
AU  - Eva Sames-Dolzer
AU  - Gregor Gierlinger
AU  - Friso M Rijnberg
AU  - Lorenzo Galletti
AU  - Gianfranco Butera
AU  - Bart Meyns
AU  - Joeri Van Puyvelde
AU  - Lliya Yemets
AU  - Elshad Bairamov
AU  - Andrzey Kansy
AU  - Matej Nosal
AU  - Marien Lenoir
AU  - Gaetano Gargiulo
AU  - Emanuela Angeli
AU  - Thomas Martens
AU  - Thierry Bove
AU  - Carlo Pace Napoleone
AU  - Mauro Lo Rito
AU  - Alessandro Giamberti
AU  - Konstantinos Dimopoulos
AU  - Claudia Montanaro
AU  - Stefano Marianeschi
AU  - Alvaro Gonzalez Rocafort
AU  - Biagio Castaldi
AU  - Dario Gregori
AU  - Giovanni Di Salvo
AU  - Giovanni Meliota
AU  - Gabriele Scalzo
AU  - Giuseppe Scrascia
AU  - Guido Michielon
AU  - Vladimiro Vida
AU  - George Sarris
AU  - Andrew Constantine
AU  - Massimo A Padalino
PY  - 2026
DA  - 2026/07/24
JO  - JTCVS open
DO  - 10.1016/j.xjon.2026.101970
UR  - https://europepmc.org/article/MED/42948481
AB  - Objective  The Fontan procedure is a crucial surgical intervention for single-ventricle physiology, with the extracardiac conduit (ECC) and lateral tunnel (LT) techniques being the predominant approaches. This study aimed to compare early and late clinical outcomes of ECC and LT, using inverse probability of treatment weighting (IPTW) to ensure robust assessments.Methods  A retrospective analysis of 3300 patients from the EUROFONTAN registry was conducted, with data collected from 21 European centers. The cohort included 3010 patients who underwent the ECC technique and 290 patients who underwent the LT technique. IPTW was used to balance baseline characteristics. Primary outcomes were early and late mortality, Fontan failure, and adverse events. Secondary outcomes included postoperative complications and nonsurgical adverse events.Results  Propensity-matched analysis showed significantly better outcomes for ECC. Early mortality was lower for ECC (1.2% vs 3.9%, P = .003), whereas late mortality at 20-year follow-up was 8.6% in LT versus 3.2% in ECC after IPTW (P = .003). Patients who underwent the ECC technique experienced fewer postoperative complications (47% vs 66%, P = .025) and less frequent Fontan failure (12% vs 19%, P = .032). Kidney-related events were more frequent in patients who underwent the LT technique (3% vs 0.6%, P = .004). The development of arrhythmia initially appeared greater in the LT group but equalized after matching. Long-term complications, such as protein-losing enteropathy and hepatic issues, showed no significant differences.Conclusions  ECC was associated with better early and intermediate outcomes than LT in this multicenter European registry. However, surgical era and hospital center explain a substantial part of the observed difference. Continued long-term surveillance of the Fontan pathway is essential to optimize lifelong outcomes.
SN  - 2666-2736
ER  -