Less invasive establishment of the Fontan circulation in terms of earlier farewell to a cyanotic circulation

: To promote further improvement of surgical results in the longer terms after the Fontan procedure, we have paid attention to age at operation. Establishment of a non-cyanotic circulation at younger stage, for example around 1 year of age, could have potential advantages in postoperative cardiac performance and functional status. In order to commence the Fontan circulation safe and sound, in turn, the surgical intervention ought to be arranged in a less invasive fashion. In this respect, we introduced off-pump Fontan procedure. Since April 1996, 77 patients have undergone the off-pump Fontan procedure. Its less invasive nature was demonstrated in terms of inflammatory reaction immediately after the operation. Further devices are being sought. These include an alternative off-pump procedure even without a temporary bypass for drainage through the inferior caval vein, which has been thus far applied in 14 patients. This option proved to provide readily an excellent surgical field when an extracardiac conduit is to be anastomosed to the orifice of the inferior caval vein. Another device can be a cordial preparation of the extracardiac channel at the time of the bidirectional Glenn procedure when the staged approach is chosen.