Total cavopulmonary connection with extraatrial tunnel.

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complex congenital heart disease presents significant surgical challenges.
• Previous palliative procedures may require further intervention.
• The total cavopulmonary connection (TCPC) is a surgical option for single-ventricle physiology.

Purpose of the Study:

• To evaluate the efficacy and outcomes of TCPC with an extraatrial tunnel in complex congenital heart disease.
• To identify critical factors for successful surgical outcomes.

Main Methods:

• Retrospective analysis of 9 patients undergoing TCPC with an extraatrial tunnel between April 1997 and February 2000.
• Patient diagnoses included single ventricle, double-outlet right ventricle, mitral atresia, and tricuspid atresia.
• Follow-up ranged from 11 months to 3 years.

Main Results:

• No operative mortality was observed.
• One patient required reoperation for bacterial endocarditis and tunnel replacement.
• At follow-up, 3 patients were in New York Heart Association functional class I, and 6 were in class II.
• Refractory supraventricular tachycardia in one patient was successfully treated by the TCPC procedure.

Conclusions:

• TCPC with an extraatrial tunnel is a safe and effective treatment for selected complex congenital heart disease.
• Favorable outcomes are associated with appropriate surgical indications, avoidance of aortic cross-clamping and cardiac arrest, and unobstructed vascular anastomoses.
• This technique can resolve complex arrhythmias in patients with single-ventricle physiology.