Total cavopulmonary connection with an extracardiac conduit: experience with 100 patients

• Published in: The Annals of thoracic surgery Vol. 73; no. 1; pp. 76 - 80
• Main Authors: Tokunaga, Shigehiko, Kado, Hideaki, Imoto, Yutaka, Masuda, Munetaka, Shiokawa, Yuichi, Fukae, Kouji, Fusazaki, Naoki, Ishikawa, Shiro, Yasui, Hisataka
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2002; Elsevier Science
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Child, Preschool; Extracorporeal Circulation; Fontan Procedure - methods; Fontan Procedure - mortality; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Medical sciences; Pulmonary Atresia - mortality; Pulmonary Atresia - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Tricuspid Atresia - mortality; Tricuspid Atresia - surgery; 21; Human; Prognosis; Bypass; Surgery; Mortality; Biomaterial; Cavopulmonary; Technique; Fontan operation; Comparative study; Morbidity
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(01)03302-1

Background. In the Fontan procedures total cavopulmonary connection with an extracardiac conduit is a concern. The potential benefits of an extracardiac conduit may be the avoidance of postoperative supraventricular arrhythmias over the long-term, hemodynamic benefits due to laminar flow, possibility of completion without anoxic arrest, and applicability to anomalous systemic or pulmonary venous return, or both anomalous systemic and pulmonary venous return. We demonstrate early to midterm results of total cavopulmonary connection with an extracardiac conduit. Methods. Between March 1994 and February 2000, a total of 100 patients underwent total cavopulmonary connection with an extracardiac conduit. In 27 patients, who underwent a single stage total cavopulmonary connection operation, 7 were done without palliation. Seventy-three patients had undergone a bidirectional Glenn shunt before completion of the total cavopulmonary connection. We used an expanded polytetrafluoroethylene tube graft as the extracardiac conduit. Results. Cardiopulmonary bypass time was 133.2 ± 55.2 minutes. Myocardial ischemic time was 38.5 ± 23.2 minutes in 40 patients who needed cardioplegic cardiac arrest for intracardiac procedures. Intraoperative fenestration was done in only 1 patient. There were no operative deaths. During follow-up of 37.3 months, there were 5 late deaths. When compared with the patients treated by the lateral tunnel technique in our institute, there was no significant difference in actuarial survival rate, but the event free rate of the extracardiac conduit group was significantly superior to the lateral tunnel group. Conclusions. Total cavopulmonary connection with the extracardiac conduit produced good results in short to midterm follow-up.