title: [Total cavopulmonary anastomosis: risk factors and results in patients under 4 years of age].
abstract: 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.
authors.affiliation: Klinik mit Poliklinik für Kinder und Jugendliche der Universität Erlangen-Nürnberg.
authors.forename: M
authors.initials: M
authors.lastname: Hofbeck
authors.forename: H
authors.initials: H
authors.lastname: Singer
authors.forename: J
authors.initials: J
authors.lastname: Scharf
authors.forename: T
authors.initials: T
authors.lastname: Rupprecht
authors.forename: M
authors.initials: M
authors.lastname: Ries
authors.forename: G
authors.initials: G
authors.lastname: Buheitel
authors.forename: U
authors.initials: U
authors.lastname: Blum
authors.forename: O
authors.initials: O
authors.lastname: Mahmoud
authors.forename: J V
authors.initials: JV
authors.lastname: Emde
mesh_terms: 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