The outcomes of the extracardiac total cavopulmonary connection in 130 consecutive patients with single-ventricle physiology
Abstract
Fontan procedure has gone through several modifications and today is the primary palliation to treat a broad spectrum of com-plex congenital heart defects.
The aim of this study is to present the results of treatment of children and adults with a single ventricle.
Materials and methods. Since 2005 to 2015 years, in 130 consecutive patients with a single ventricle morphology aged 9,97±4,37 years the extracardiac total cavopulmonary connection was performed. The most common heart pathology was tricus-pid atresia (26,9%). In 118 (90,8%) patients, the operation was carried out with the moderately hypothermic cardiopulmonary bypass, without aortic cross-clamp. The average cardiopulmonary bypass time was 94,2±56,6 min. In the remaining twelve patients extracardiac TCPC was carried out without CPB.
Results. There were three (2,3%) early deaths. The median duration of the mechanical ventilation was 9,7±16,1 h (1–71 h). The average length of stay was 17,5±18,5 days (8,0–81,0 days).
Conclusions. Improved understanding of single-ventricle physiology, patient preparation, surgical techniques, and post-operative care has allowed us to reach a steady state in the early outcomes after TCPC.
References
2. The Fontan circulation: who controls cardiac output? / Gewillig M., Brown S. C., Eyskens B. et al. // Interact Car-diovasc Thorac Surg. – 2010. – Vol. 10. – P. 428–33.
3. De Leval M. R. Evolution of the Fontan-Kreutzer pro-cedure // Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. – 2010. – Vol. 13. – P. 91–5. doi:10.1053/j. pcsu.2010.01.006
4. Celermajere and Yves d’Udekem. The extracardiac conduit Fontan procedure in Australia and New Zealand: hypoplastic left heart syndrome predicts worse early and late outcomes / Ajay J. Iyengara, David S. Winlawd, John C. Galatib et al. // European Journal of Cardio-Thoracic Surgery. – 2014. – Vol. 46. – P. 465–73.
5. Зіньковський М. Ф., Кривенький О. В., Яковенко І. Г. Роль кавопульмонального анастомозу в хірургічному лікуванні вроджених аномалій серця з функціонально єдиним шлуночком // Серце і судини. – 2003. – № 2. – С. 73–80.
6. Contemporary Fontan operation: association between ear-ly outcome and type of cavopulmonary connection / Stew-art R. D., Pasquali S. K., Jacobs J. P. et al. // Ann Thorac Surg. – 2012. – Vol. 93. – P. 1254–60.
7. Ventricular function and cardiac reserve in contemporary Fontan patients / Bossers S. S., Kapusta L., Kuipers I. M. et al. // Int J Cardiol. – 2015. – Vol. 196. – P. 73–80.
8. Contemporary Fontan Operation: Association between Early Outcome and Type of Cavopulmonary Connection / Robert D. Stewart, Sara K. Pasquali, Jeffrey P. Jacobs et al. // Ann Thorac Surg. – 2012 Apr. – Vol. 93 (4). – P. 1254–61.
9. Hemodynamic phenotype of the failing fontan in an adult population / Hebson C. L., McCabe N. M., Elder R. W. et al. // Am. J. Cardiol. – 2013. – Vol. 112. – P. 1943–7.
10. Incidence and Etiology of Chylothorax after Congenital Heart Surgery in Children / Akbari Asbagh P., Navabi Shirazi M. A., Soleimani A. et al. // J Teh Univ Heart Ctr. – 2014. – Vol. 9 (2). – P. 59–63.
11. An international multicenter study comparing arrhythmia prevalence between the intracardiac lateral tunnel and the extracardiac conduit type of Fontan operations / Balaji S., Daga A., Bradley D. J. et al. // J Thorac Cardiovasc Surg. – 2014. – Vol. 148 (2). – P. 576–581.
12. Rajanbabu B. B. Arrhythmia prevalence after extra cardiac conduit Fontan: a viewpoint // J Thorac Cardiovasc Surg. – 2015. – Vol. 149 (4). – P. 1223–4.
13. A multicenter, randomized trial comparing heparin/warfarin and acetylsalicylic acid as primary thromboprophylaxis for 2 years after the Fontan procedure in children / Monagle P., Cochrane A., Roberts R. et al. // J Am Coll Cardiol. – 2011 Aug 2. – Vol. 58 (6). – P. 645–51.
14. Prevalence and predictors of haemostatic complications in 412 Fontan patients: their relation to anticoagulation and haemodynamics / Ohuchi H., Yasuda K., Miyazaki A. et al. // Eur J Cardiothorac Surg. – 2015. – Vol. 47 (3). – P. 511–9.
15. Firdouse M., Agarwal A., Chan A. K., Mondal T. Thrombosis and Thromboembolic Complications in Fontan Patients: A Literature Review // Clin Appl Thromb Hemost. – 2014 Jan 24. – Vol. 20 (5). – P. 484–92.
