title: A complete extracorporeal circulation-free approach to patients with functionally univentricular hearts provides superior early outcomes.
abstract: OBJECTIVE
  We compared the early outcomes of patients undergoing extracardiac total cavopulmonary connection (TCPC) with or without cardiopulmonary bypass (CPB).
  
  
  METHODS
  Between February 2012 and February 2013, 27 patients undergoing TCPC without CPB (off-pump group) were compared with matched 27 patients undergoing TCPC on CPB (on-pump group). Outcome parameters studied were inotropic score, time to extubation, intensive care unit (ICU) stay, first 12 hours mediastinal drainage in ICU, average pleural drainage, time to removal of chest tubes, total hospital stay, and saturation at discharge.
  
  
  RESULTS
  There was one early death in each group. No patient required conversion from off CPB to CPB. The inotropic score (6.1 ± 5.91 vs 10.1 ± 6.80, P = .03), time to extubation (8.7 ± 6.95 vs 10.31 ± 8.69 hours, P = .03), first 12 hours mediastinal drainage in ICU (611.9 ± 341.4 vs 922.2 ± 145.6 mL, P = .03), and ICU stay (1.6 ± 0.58 vs 2.9 ± 1.37 days, P = .001) were significantly less in the off-pump group when compared to the on-pump group, and saturation at discharge (99.7 ± 0.60 vs 98.6 ± 2.13, P = .026) was higher in the off-pump group. However, the average daily pleural drainage (125 ± 61.72 vs 150 ± 103.4 mL, P = .7), time to removal of chest tubes (12.69 ± 7.1 vs 15.44 ± 19.26 days, P = .45), and the total hospital stay (14.23 ± 7.4 vs 18.89 ± 19.9 days, P = .22) were no different. There were substantial savings in costs in patients undergoing off-pump TCPC (P = .016).
  
  
  CONCLUSIONS
  The TCPC without CPB is easy to perform, is cost-effective, and is associated with superior early postoperative outcomes as compared to TCPC on CPB. With appropriate modifications, this operation can be performed in almost all morphological subsets of patients who do not need an associated intracardiac procedure.
authors.affiliation: Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Subramanian
authors.initials: S
authors.lastname: Muthukkumaran
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.forename: Neeti
authors.initials: N
authors.lastname: Makhija
authors.forename: Vishnubhatla
authors.initials: V
authors.lastname: Sreenivas
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000379:methods; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fontan operation; cardiopulmonary bypass; total cavopulmonary connection