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Total cavopulmonary connection with an extracardiac conduit: experience with 100 patients
Shigehiko Tokunaga1, Hideaki Kado, Yutaka Imoto
1Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Japan. f-kodomo@aurora.dti.ne.jp
Insights
Total cavopulmonary connection using an extracardiac conduit shows promising early to midterm results. This technique offers potential benefits like reduced arrhythmias and improved hemodynamics, with a superior event-free rate compared to the lateral tunnel method.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- The Fontan procedure is a critical surgical intervention for complex congenital heart disease.
- Extracardiac conduits in total cavopulmonary connection (TCPC) are being evaluated for potential advantages.
- Concerns exist regarding long-term outcomes and complications associated with traditional TCPC methods.
Purpose of the Study:
- To evaluate the early to midterm clinical outcomes of TCPC utilizing an extracardiac conduit.
- To compare the efficacy and safety of extracardiac conduits versus the lateral tunnel technique in Fontan procedures.
- To assess the potential benefits of extracardiac conduits, including hemodynamic advantages and arrhythmia reduction.
Main Methods:
- A cohort of 100 patients underwent TCPC with an extracardiac conduit (expanded polytetrafluoroethylene tube graft) between March 1994 and February 2000.
- Patients included those undergoing single-stage TCPC (with or without palliation) and those with prior bidirectional Glenn shunt.
- Surgical details such as cardiopulmonary bypass time and myocardial ischemic time were recorded.
Main Results:
- No operative deaths were observed in the study cohort.
- During a mean follow-up of 37.3 months, 5 late deaths occurred.
- The extracardiac conduit group demonstrated a significantly superior event-free rate compared to the lateral tunnel technique group, with similar actuarial survival rates.
Conclusions:
- Total cavopulmonary connection with an extracardiac conduit yields favorable early to midterm results.
- The extracardiac conduit approach appears to be a safe and effective alternative for TCPC.
- This technique may offer improved long-term outcomes, particularly regarding event-free survival.
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.