title: Long-term results of total cavopulmonary connection with low ejection fraction.
abstract: OBJECTIVE
  The aim of this study was to investigate the surgical outcomes and change in cardiac performance after total cavopulmonary connection (TCPC) in patients with reduced ventricular ejection preoperatively.
  
  
  METHODS
  Among the 195 patients undergoing TCPC between 1990 and 2001 were 52 who had a preoperative ejection fraction of ≤50% (30%-50%, mean 44%). A dominant ventricle was of the morphologically right type in 81% of patients.
  
  
  RESULTS
  A total of 9 of the 52 patients died early. Two patients died in the intermediate term. Postoperative exercise testing showed maximum oxygen uptake of 26.4 ± 5.8 ml/kg/min (anaerobic threshold 18.3 ± 3.2 ml/kg/ min). The cardiac index was 3.1 ± 0.9 l/min/m(2) at 1 year after TCPC, with no fundamental change at 5 years (3.1 ± 0.8 l/min/m(2)). The end-diastolic volume of the dominant ventricle was 130% ± 74% of the anticipated normal value at 1 year and 93% ± 27% at 5 years after TCPC, with ejection fractions of 48% ± 13% and 49% ± 9%, respectively. When these parameters were plotted for the individual patients, the ejection fraction increased during the first postoperative year, with the percent end-diastolic volume decreasing in 31 survivors; the trend appeared atypical in the remaining 12 survivors. Even in these patients, however, the parameters eventually changed toward favorable circumstances 5 years after TCPC.
  
  
  CONCLUSIONS
  Change in ventricular function was not necessarily pessimistic after TCPC in patients with reduced ventricular contraction preoperatively.
authors: Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Fujishiro-dai, Suita, Osaka, Japan. sshuichi@med.niigata-u.ac.jp
authors: Shuichi
authors: S
authors: Shiraishi
authors: Hideki
authors: H
authors: Uemura
authors: Koji
authors: K
authors: Kagisaki
authors: Ikuo
authors: I
authors: Hagino
authors: Junjiro
authors: J
authors: Kobayashi
authors: Masashi
authors: M
authors: Takahashi
authors: Toshikatsu
authors: T
authors: Yagihara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005080:Exercise Test; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007564:Japan; D053208:Kaplan-Meier Estimate; D009200:Myocardial Contraction; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function; D017725:Ventricular Pressure