[Total cavopulmonary anastomosis: risk factors and results in patients under 4 years of age].
In recent years, an increasing number of modified Fontan-operations has been performed in children younger than 4 years of age. The purpose of this study was to identify preoperative risk factors in this age group. From February 1990 until February 1993, we performed in our center a modified Fontan-operation using the technique of total cavopulmonary anastomosis (TCPA) in 37 consecutive patients (17 pts. < 4 years = group I, 20 pts. > 4 years = group II). Early postoperative mortality occurred in patients of group I only (n = 3 pts.). All of these patients had additional preoperative risk factors. Pulmonary vascular resistance (PVRI) > 2 U x m2 was a significant risk factor for the younger patients while pulmonary artery size alone (expressed as the McGoon-ratio or Nakata-index) could not be identified as a separate risk factor. Using two additional indices (McGoon-ratio/PVRI and Nakata-index/PVRI), we were able to identify patients with unfavorable postoperative hemodynamics as high-risk patients. In our experience, TCPA can be performed in patients younger than 4 years of age with a low mortality, if there are no additional preoperative risk factors. For high-risk patients we recommend either a bidirectional Glenn-anastomosis as a first step procedure or a TCPA with fenestration of the intraatrial tunnel-patch.
Hofbeck
M
M
Klinik mit Poliklinik für Kinder und Jugendliche der Universität Erlangen-Nürnberg.
Singer
H
H
Scharf
J
J
Rupprecht
T
T
Ries
M
M
Buheitel
G
G
Blum
U
U
Mahmoud
O
O
Emde
J V
JV
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D018785:Tricuspid Atresia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery