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[Midterm Outcomes and Therapeutic Effects of Total Cavopulmonary Connection (TCPC) Conversion]

Toshimichi Nonaka1, Yuson Wada, Takuya Osawa

  • 1Department of Cardiovascular Surgery, JCHO Chukyo Hospital, Nagoya, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|July 4, 2019
PubMed

Insights

Total cavopulmonary connection (TCPC) conversion is a safe and effective procedure for patients with Fontan-associated complications. This surgical approach significantly improves cardiac function and survival rates, offering favorable midterm outcomes.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Congenital Heart Disease Surgery

Background:

  • Late complications can arise after the atrio-pulmonary-Fontan procedure.
  • Total cavopulmonary connection (TCPC) conversion is a surgical strategy to mitigate these late complications.
  • The long-term outcomes and effects of TCPC conversion require further investigation.

Purpose of the Study:

  • To evaluate the surgical and midterm outcomes of TCPC conversion.
  • To assess the impact of TCPC conversion on patient survival and cardiac events.
  • To identify common perioperative and late complications following TCPC conversion.

Main Methods:

  • TCPC conversion was performed in 31 patients between 2004 and 2017.
  • Concomitant procedures included anti-arrhythmia surgery (90%), atrioventricular valve surgery (4 patients), and pacemaker implantation (2 patients).
  • Patient outcomes, including survival, cardiac events, and cardiac index, were analyzed.

Main Results:

  • No perioperative deaths occurred; one late death was attributed to protein-losing gastroenteropathy.
  • Five-year survival rate was 96.8%, with a 5-year cardiac event-free rate of 67.7%.
  • The cardiac index significantly improved from 1.58 L/min/m² preoperatively to 3.57 L/min/m² postoperatively (p=0.0075).

Conclusions:

  • TCPC conversion demonstrates favorable surgical and midterm outcomes.
  • Atrial arrhythmia was the most frequent reason for therapeutic intervention in both perioperative and late periods.
  • TCPC conversion is an effective therapeutic procedure for managing late complications after the Fontan procedure.

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