Journal of cardiothoracic and vascular anesthesia
September 25, 2026 · via Europe PMC
Competing Hemodynamic Goals During Hepatectomy in Patients with Fontan Circulation: A Systematic Review of Case Reports.
Minote T, Yonezawa H, Kinoshita M, Tanaka K
AI summary — for doctors, generated from the abstract only
Hepatectomy appears feasible in selected patients with stable Fontan circulation when CVP is kept near baseline, but congestion complications are common.
What was studied
Systematic review of case reports and series covering 31 Fontan patients from 28 studies who underwent open or laparoscopic hepatectomy, mostly for hepatocellular carcinoma.
Key findings
- No perioperative mortality was reported; all had stable Fontan physiology
- Management favored baseline CVP (10-15 mmHg) over low-CVP targets, with pneumoperitoneum kept below baseline CVP
- IVC clamping caused significant hypotension; the Pringle maneuver was well tolerated
- Median blood loss 1,106 mL (range 10-4,130); postoperative ascites, effusions and fluid retention were most common
Clinical relevance
Anesthesiologists and surgeons face competing goals in Fontan patients, and this synthesis offers practical hemodynamic targets.
Who should care
Limitations
Evidence comes only from case reports, with publication and selection bias toward good outcomes and no hepatectomy-specific risk stratification.
Keep CVP near baseline, avoid raising pulmonary vascular resistance, limit pneumoperitoneum pressure and avoid IVC clamping where possible.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
OBJECTIVES
To synthesize available evidence on perioperative management and clinical outcomes of hepatectomy in patients with Fontan circulation, focusing on hemodynamic strategies and surgical safety.
DESIGN
A systematic review of case reports and case series.
SETTINGS
Published studies were identified through databases (PubMed, Scopus, Cochrane Library, Google Scholar, ICHUSHI, and CiNii Research).
PARTICIPANTS
Thirty-one patients from 28 studies underwent hepatectomy after the Fontan procedure.
INTERVENTIONS
Open or laparoscopic hepatectomy, primarily for hepatocellular carcinoma in the setting of Fontan-associated liver disease.
MEASUREMENTS AND MAIN RESULTS
All patients had stable Fontan physiology, and no perioperative mortality was reported. Preoperative baseline central venous pressure (CVP) ranged from 10 to 15 mmHg. Intraoperative management consistently favored a baseline-CVP strategy over conventional low-CVP targets. Laparoscopic approaches uniformly used low-pressure pneumoperitoneum below baseline-CVP levels. The Pringle maneuver was well tolerated; however, inferior vena cava clamping was associated with significant hypotension. The median blood loss was 1,106 mL (range 10-4,130 mL). Congestion-related complications, including ascites, pleural effusion, heart failure, and unspecified fluid retention, were most commonly reported postoperatively.
CONCLUSION
Hepatectomy appears feasible in carefully selected patients with stable Fontan circulation. Practical perioperative considerations summarized from reported patterns include maintaining CVP near baseline, minimizing increases in pulmonary vascular resistance, and keeping pneumoperitoneum pressure below baseline CVP during laparoscopic surgery. However, hepatectomy-specific risk stratification has yet to be established, and optimal perioperative management of patients with impaired Fontan physiology remains uncertain. A critical knowledge gap remains regarding hemostatic approaches that optimize bleeding control while preserving the Fontan circulation.
DOI
10.1053/j.jvca.2026.09.044
PMID
42892563
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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