Viable extracardiac total right heart bypass: technical considerations and mid-term results

Direct connection of both caval veins to the pulmonary arterial system would be the ideal right heart bypass by virtue of elimination of prosthetic material and extensive atrial suture lines. However, it can be applied only to selected patients with peculiar anatomical arrangements. We decided to perform total extracardiac right heart bypass using pedicled in situ pericardium in situations when a direct connection was not possible.

A cohort of five patients, aged 3.5, 4, 10, 10 and 31 years, respectively, with complex cyanotic congenital heart diseases were candidated to extracardiac total cavopulmonary connection using viable in situ pericardium. Aortic cross-clamp was completely avoided in all patients.

There was no early or late death. Postoperatively, all patients are in functional class I and in normal sinus rhythm at a mean follow-up of 30 months (S.D.=+/-19 months). Postoperative serial echocardiograms revealed wide, unrestricted anastomoses, unobstructed venous flow to both pulmonary arteries with cardiac pulsations and respiratory variations in the pulmonary arteries due to compressible lateral tunnel. Cavopulmonary angiograms (n=5) in late postoperative period have demonstrated a smooth, nonturbulent, somewhat pulsatile flow without pressure gradient.

The technical advantages and haemodynamic benefits of this operation are encouraging. A longer follow-up is needed to confirm the early results, especially late atrial dysrrhythmias, pulmonary venous obstruction, thromboembolic complications and growth of the conduit.