[Lateral tunnel versus extracardiac cavopulmonary connections]

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Cardiovascular Surgery

Background:

• The Fontan procedure is a palliative surgery for single-ventricle physiology.
• Total cavopulmonary connection (TCPC) is a common surgical approach.
• Lateral tunnel (LT) and extracardiac conduit (EC) are two primary TCPC techniques.

Purpose of the Study:

• To evaluate the mid-term outcomes of the lateral tunnel (LT) total cavopulmonary connection (TCPC).
• To compare the results of LT TCPC with the extracardiac conduit (EC) TCPC procedure.

Main Methods:

• A retrospective review of 72 LT and 28 EC TCPC surgeries performed between March 1991 and May 2002.
• LT creation involved incising the right atrium and using autologous atrial wall.
• LT size was determined based on body weight relative to pulmonary artery size.

Main Results:

• One early and one late death occurred in the LT group.
• Supraventricular tachycardia (SVT) was observed in 1 EC patient and 4 LT patients (all with heterotaxy syndrome).
• No significant differences in mortality or morbidity were found between LT and EC TCPC.

Conclusions:

• Lateral tunnel total cavopulmonary connection demonstrates comparable mid-term outcomes to extracardiac conduit TCPC.
• LT TCPC is particularly advantageous for small infants and children undergoing complex cardiac repair.
• Both LT and EC TCPC are viable options for palliative treatment of single-ventricle defects.