Vasopressin as a postoperative management strategy in Fontan procedure: a comparative study.

Purpose: The Fontan procedure is crucial for managing univentricular heart conditions but can lead to prolonged pleural effusions, affecting recovery and hospital stays. This study evaluated the effectiveness of vasopressin in reducing pleural effusion and improving recovery outcomes following Fontan procedure.

Methods: This comparative observational study reviewed patient records from October 2021 to September 2023. Two cohorts were included of 23 patients each: patients who received postoperative vasopressin from October 2022 to September 2023 (VP group) and a historical control group from the previous year (NVP group), excluding those who underwent fenestrated Fontan. Vasopressin was administered postoperatively to the VP group to mitigate pleural effusion. Primary outcomes were the volume and duration of chest tube drainage. Secondary outcomes included hospital and intensive care unit (ICU) stay durations and fluid balance metrics.

Results: There were no significant differences in the primary or secondary outcomes between the vasopressin group and the control group. The median total drain outputs in the VP and NVP groups were 69.4 ml/kg and 53.9 ml/kg, respectively ( = 0.96). The median duration of chest tube stay was 5.5 days for the VP group and 6 days for the NVP group ( = 0.74). Hospital stay duration ( = 0.74) and ICU stay duration ( = 0.82) showed no significant difference.

Conclusion: Vasopressin does not significantly impact chest tube drainage volume or duration, nor does it reduce hospital stays in Fontan patients, suggesting a limited role in managing postoperative pleural effusions. Further research is needed to explore its benefits for specific patient subgroups and acute hemodynamic instabilities postoperatively.

Supplementary Information: Below is the link to the electronic supplementary material. 10.1007/s12055-024-01873-9.