[Total cavo-pulmonary bypass. Short-term results].
In order to reduce the complications of the Fontan procedure, 2 techniques of total cavopulmonary connection using a right intra-atrial baffle (Pugas' technique, 19 patients), and a modified de Kreutzer (19 patients) were assessed in 38 consecutive patients operated between November 1980 and November 1991. All patients had complex cyanotic congenital heart disease: tricuspid atresia (13), single ventricle (12), hypoplasia of one of the two ventricles (8), pulmonary atresia with an intact septum (5). The average age was 5.8 +/- 5.6 years (range 1 to 30 years), the weight was 18 +/- 11.7 kg (range 8 to 59.7 kg). Six patients (15.8%) died, 4 of whom (10.5%) in the operative period. Five of these deaths were related to extremely high right heart pressures without any technical fault, and the other to thrombosis of the conduit in a patient not taking anticoagulants. Two immediate and 10 secondary reoperations were necessary. All 3 patients who had disconnection of the anastomosis because of high right heart pressures died. The postoperative course was often difficult: right heart failure (63%), pleural effusion (57%), and pericardium effusion (13%). Of the risk factors analysed, age had no influence on postoperative outcome. The two poor prognostic factors were: presence of atresia or hypoplasia of the systemic atrioventricular valve (mortality 42.8% versus 6.5%, p = 0.05 and prolongation of the hospital period: 39.5 +/- 32 days versus 21 +/- 11 days, p less than 0.05) and previous banding (reoperation rate 62.5% versus 16.6%, p less than 0.05, and longer stay in the intensive care unit and hospital period).(ABSTRACT TRUNCATED AT 250 WORDS)
Houyel
L
L
Centre chirurgical Marie-Lannelongue, université Paris-Sud, Le Plessis-Robinson.
Petit
J
J
Bruniaux
J
J
Serraf
A
A
Lacour-Gayet
F
F
Planché
C
C
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D014683:Vena Cava, Superior / Q000601:surgery
Dérivations cavo-pulmonaires totales. Résultats à court terme.