The impact of extracardiac conduit-total cavopulmonary connection on apicocaval juxtaposition☆

• DOI: 10.1016/j.ejcts.2010.02.032
• Publication Date: 2010-07-22T06:58:56Z
• Authors: Takahisa Sakurai; Hideaki Kado; Toshihide Nakano; Kazuhiro Hinokiyama; Shinichiro Oda; Junya Sugiura; Tomoki Ushijima; Yuichi Ueda
• Keywords: Electrical conduit

Objectives: Modifications of the Fontan procedure are applied to a wide range complex congenital heart defects with single ventricle physiology. We examined pathway and clinical results extracardiac conduit-total cavopulmonary connection (EC-TCPC) for malpositioned apicocaval juxtaposition. Methods: Of 365 patients who underwent EC-TCPC since 1994, 56 juxtaposition were included in this retrospective study (group 1). The EC was selected after careful consideration preoperative angiography computed tomography, as well intra-operative findings. A concurrent group 299 undergoing without used control 2). mean follow-up periods groups 1 2 5.5 years (range: 0–12 years) 0–14 years), respectively. Results: age at operation 4.2 ± 3.2 median size conduit 18 mm 16–20 mm). In 30 patients, placed between inferior venacava (IVC) opposite side pulmonary artery crossing vertebra. another 25 positioned behind IVC on same (PA). There one patient had Y-style right left PAs ventricle. 1, there no early deaths; three died intermediate term due gastric bleeding one, haemoptysis sudden death yet another. None developed stenosis or venous obstruction, required re-operation. Three late complications, including arrhythmias requiring medication two subdural haematoma one. incidence complications did not differ among pathways conduits. 2, eight deaths, 27 complications. Kaplan–Meier survival rate 93.5% 5 10 97.3% 96.1% (log-rank test, P = 0.29). haemodynamics during identical respect pressure (8.9 2.5 9.6 2.6 mmHg 2), ventricular end-diastolic (4.4 4.3 mmHg, respectively), cardiac index (3.3 3.4 l min−1 m−2, respectively) arterial oxygen saturation (94 94.2%, respectively). No either gradient >2 central PA. Postoperative catheterisation data showed significant differences 1. Conclusions: can be performed children excellent mid-term outcomes compared other candidates. Based individual anatomy, vertebra obstruction.