title: [Total cavopulmonary anastomosis for definitive palliation of complex univentricular cardiovascular systems--potential preoperative risk factors].
abstract: The modified Fontan operation for definitive palliation has been performed in an increasing number of patients with various forms of a functionally univentricular heart. To eliminate the influence of different surgical techniques only patients after total cavopulmonary anastomosis (TCPA) were included in this retrospective analysis of preoperative risk factors. The age at operation in 72 patients varied from 7 to 219 months (median 54 months); 29 patients had been younger than 4 years. Forty-nine patients presented with a complex form of a functionally univentricular heart; associated systemic- or pulmonary venous anomalies were found in 22 patients, AV valve abnormalities in 42 patients with AV valve incompetence in 21 patients. Preoperative hemodynamic data revealed an elevated mean pulmonary artery pressure (> 15 mm Hg), increased pulmonary arteriolar resistance (> 3 U.m2) or end-diastolic ventricular pressure (> 12 mm Hg) in 23 patients. The overall mortality was 9.7% (7/72 patients). Variables with significant influence on postoperative mortality were associated systemic- and pulmonary venous anomalies. AV-valve incompetence and prolonged cardio-pulmonary bypass time. Age at operation, preoperative pulmonary arteriolar resistance, systemic- and pulmonary blood flow did not influence postoperative mortality. Even in patients with a complex form of a univentricular heart with associated anomalies and borderline preoperative hemodynamics TCPA can be performed with an acceptable risk.
authors.affiliation: Abteilung III und pädiatrische Kardiologie Medizinische Hochschule Hannover.
authors.forename: R
authors.initials: R
authors.lastname: Kaulitz
authors.forename: H
authors.initials: H
authors.lastname: Hecker
authors.forename: I
authors.initials: I
authors.lastname: Luhmer
authors.forename: J
authors.initials: J
authors.lastname: Feickert
authors.forename: G
authors.initials: G
authors.lastname: Ziemer
authors.forename: H C
authors.initials: HC
authors.lastname: Kallfelz
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000601:surgery; D012307:Risk Factors; D015996:Survival Rate; D014683:Vena Cava, Superior / Q000601:surgery