Total cavopulmonary connection with an extracardiac conduit: experience with 100 patients.
BACKGROUND
In the Fontan procedures total cavopulmonary connection with an extracardiac conduit is a concern. The potential benefits of an extracardiac conduit may be the avoidance of postoperative supraventricular arrhythmias over the long-term, hemodynamic benefits due to laminar flow, possibility of completion without anoxic arrest, and applicability to anomalous systemic or pulmonary venous return, or both anomalous systemic and pulmonary venous return. We demonstrate early to midterm results of total cavopulmonary connection with an extracardiac conduit.


METHODS
Between March 1994 and February 2000, a total of 100 patients underwent total cavopulmonary connection with an extracardiac conduit. In 27 patients, who underwent a single stage total cavopulmonary connection operation, 7 were done without palliation. Seventy-three patients had undergone a bidirectional Glenn shunt before completion of the total cavopulmonary connection. We used an expanded polytetrafluoroethylene tube graft as the extracardiac conduit.


RESULTS
Cardiopulmonary bypass time was 133.2+/-55.2 minutes. Myocardial ischemic time was 38.5+/-23.2 minutes in 40 patients who needed cardioplegic cardiac arrest for intracardiac procedures. Intraoperative fenestration was done in only 1 patient. There were no operative deaths. During follow-up of 37.3 months, there were 5 late deaths. When compared with the patients treated by the lateral tunnel technique in our institute, there was no significant difference in actuarial survival rate, but the event free rate of the extracardiac conduit group was significantly superior to the lateral tunnel group.


CONCLUSIONS
Total cavopulmonary connection with the extracardiac conduit produced good results in short to midterm follow-up.
Tokunaga
Shigehiko
S
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Japan. f-kodomo@aurora.dti.ne.jp
Kado
Hideaki
H
Imoto
Yutaka
Y
Masuda
Munetaka
M
Shiokawa
Yuichi
Y
Fukae
Kouji
K
Fusazaki
Naoki
N
Ishikawa
Shiro
S
Yasui
Hisataka
H
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D018633:Pulmonary Atresia / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D018785:Tricuspid Atresia / Q000401:mortality / Q000601:surgery