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Conduit Route Selection for Total Cavopulmonary Connection in Patients With Apicocaval Juxtaposition

Weidan Chen1, Ye Lu1, Li Ma1

  • 1Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China.

Seminars in Thoracic and Cardiovascular Surgery
|July 17, 2018
PubMed

Insights

Total cavopulmonary connection (TCPC) in patients with apicocaval juxtaposition (ACJ) can be safely performed. The preferred conduit route is between the inferior vena cava (IVC) and the ipsilateral pulmonary artery, yielding excellent outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Apicocaval juxtaposition (ACJ) presents challenges in conduit pathway selection for total cavopulmonary connection (TCPC) in single-ventricle patients.
  • Optimal surgical strategy is crucial for successful TCPC in this complex anatomical scenario.

Purpose of the Study:

  • To review surgical experience and evaluate clinical outcomes of TCPC in patients with ACJ.
  • To determine the preferred conduit pathway for TCPC in the presence of ACJ.

Main Methods:

  • Retrospective review of 128 patients undergoing TCPC, with 31 patients diagnosed with ACJ.
  • Analysis of conduit pathway selection: IVC to ipsilateral pulmonary artery (n=24), IVC to contralateral pulmonary artery (n=5), and intra/extracardiac Fontan (n=2).
  • Comparison of perioperative and postoperative data with non-ACJ patients undergoing extracardiac TCPC.

Main Results:

  • Mean age at surgery: 58.5 months; mean body weight: 16.2 kg.
  • Mean postoperative pulmonary artery pressure: 15 mm Hg.
  • No significant difference in postoperative data compared to non-ACJ patients; no early or late conduit complications observed.

Conclusions:

  • Total cavopulmonary connection (TCPC) can be performed with excellent early and midterm results in patients with apicocaval juxtaposition (ACJ).
  • The conduit pathway between the inferior vena cava (IVC) and the ipsilateral pulmonary artery is the preferred and effective surgical approach.
  • This strategy ensures favorable outcomes, minimizing complications in single-ventricle palliation with ACJ.

Keywords:
Apicocaval juxtapositionSingle ventricleTotal cavopulmonary connection

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