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Total cavopulmonary anastomosis in patients less than three years of age
R Kaulitz1, G Ziemer, I Luhmer
1Division of Pediatric Cardiology, Children's Hospital, Hannover, Germany.
Insights
Younger patients undergoing total cavopulmonary anastomosis (TCPCA) show comparable survival and early outcomes to older patients. While late atrial dysrhythmias were infrequent, younger children had more atrioventricular valve insufficiency after TCPCA.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Outcomes Research
Background:
- Younger age at modified Fontan operation was previously considered a risk factor for poorer survival.
- This study investigates early and intermediate outcomes in a cohort of very young patients undergoing the procedure.
Purpose of the Study:
- To compare the early and intermediate outcomes of total cavopulmonary anastomosis (TCPCA) in patients younger than 3 years versus older patients.
- To assess the safety and efficacy of TCPCA in very young children with congenital heart disease.
Main Methods:
- Retrospective comparison of two groups: Group I (n=26, age 7-35 months) and Group II (n=46, age 36-219 months).
- Analysis of preoperative pathology, hemodynamics, operative outcomes, and intermediate follow-up data.
- No significant differences in preoperative pathology or hemodynamics were observed between groups.
Main Results:
- Overall mortality was 9.7% (7/72) with no significant difference between groups.
- Early postoperative outcomes, including atrial dysrhythmias, pleural effusion, and reoperation rates, were similar.
- Intermediate follow-up showed low late atrial dysrhythmias (12.3%), but significantly more late atrioventricular valve insufficiency in the younger group (Group I).
Conclusions:
- Total cavopulmonary anastomosis can be safely performed in patients under 3 years of age with complex univentricular hearts.
- Clinical and hemodynamic results in young patients are comparable to older patients.
- While overall outcomes are good, increased vigilance for late atrioventricular valve insufficiency is warranted in younger patients.
Background:
As young age at modified Fontan operation was thought to be a preoperative risk factor for poorer survival, we studied early and intermediate outcome in our young patient group.
Methods:
Results in children less than 3 years of age (group I; n = 26; age range, 7 to 35 months) were compared with those in older patients (group II; n = 46; age range, 36 to 219 months). For both groups there was no significant difference with regard to preoperative pathology and hemodynamics.
Results:
With an overall mortality of 9.7% (7/72) there was no significant difference for both groups. Group I (n = 23) and group II (n = 42) survivors did not differ with respect to early postoperative incidence of atrial dysrhythmias, duration and volume of pleural effusion, or incidence of reoperation. Results on intermediate follow-up (group I, 31 +/- 14 months; group II, 44 +/- 20 months) demonstrated a relatively low incidence of late atrial dysrhythmias (12.3%; 8/65). Late atrioventricular valve insufficiency was significantly more frequent in group I patients.
Conclusions:
With similar preoperative anatomic and hemodynamic parameters including 68% of patients with complex univentricular heart, total cavopulmonary anastomosis could be performed in patients less than 3 years of age with good clinical and hemodynamic results, as achieved in older patients.