title: Early to midterm results of total cavopulmonary connection in adult patients.
abstract: BACKGROUND
  Total cavopulmonary connection (TCPC) has not been studied in adults. We investigated early and midterm morbidity and mortality in adults undergoing TCPC and assessed risk factors for mortality.
  
  
  METHODS
  Between June 1994 and October 2010, 30 adults (21.3 ± 5.5 years) underwent TCPC (extracardiac conduit). Twenty-two patients who had palliated single ventricles underwent TCPC completions and 8 patients underwent TCPC conversions. Preoperative and perioperative data were reviewed retrospectively.
  
  
  RESULTS
  Six of 9 patients with preoperative atrial flutter or fibrillation or intraatrial reentry tachycardia were treated in the catheterization room. An aortic cross-clamp was necessary in 12 patients, and 16 TCPCs were fenestrated. Mean follow-up was 51 months (range, 4-198 months). Early mortality was 10%: 2 of 8 conversions and 1 of 22 completions. There was 1 late conversion death (at 56 months postoperatively). Postoperatively, 4 patients required pacemakers and 1 patient required long-term antiarrhythmic medication, but no heart transplantations were necessary. Risk factors for early mortality were arrhythmia (p = 0.02), aortic cross-clamp (p = 0.054), and extracorporeal circulation in hypothermia (p = 0.03). Risk factors for overall mortality were conversion (p = 0.047), absence of fenestration (p = 0.036), surgery before January 2006 (p = 0.036), aortic cross-clamp (p = 0.018), extracorporeal circulation in hypothermia (p = 0.008), and arrhythmia (p = 0.005). New York Heart Association functional class had improved at the last follow-up: preoperatively, 17 patients were in class II and 12 patients were in class III versus 18 patients in class I and 9 patients in class II postoperatively (p < 0.001). At the last clinical visit, systemic ventricular function was maintained, and no late supraventricular arrhythmia was found.
  
  
  CONCLUSIONS
  Early and midterm TCPC results for adults are encouraging for completion but are disappointing for conversion. Identified risk factors for mortality should improve patient selection for TCPC.
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France. francois.roubertie@chu-bordeaux.fr
authors.forename: François
authors.initials: F
authors.lastname: Roubertie
authors.forename: Julien
authors.initials: J
authors.lastname: Peltan
authors.forename: Roland
authors.initials: R
authors.lastname: Henaine
authors.forename: Pierre
authors.initials: P
authors.lastname: Oses
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
authors.forename: Nadir
authors.initials: N
authors.lastname: Tafer
authors.forename: Xavier
authors.initials: X
authors.lastname: Roques
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014684:Venae Cavae / Q000601:surgery*; D055815:Young Adult