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[Short- and medium-term results of cavo-pulmonary anastomosis]
1Service des maladies cardiovasculaires infantiles et congénitales, hôpital cardiologique, CHRU de Lille.
Insights
Total cavo-pulmonary connections show satisfactory medium-term results for complex univentricular heart defects. This surgical procedure improved oxygen saturation and patient outcomes, offering a viable treatment option.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Complex univentricular heart malformations present significant surgical challenges.
- Total cavo-pulmonary connection (TCPC) is a palliative surgical procedure aimed at improving oxygenation in patients with single ventricle physiology.
Purpose of the Study:
- To evaluate the medium-term results of total cavo-pulmonary connections in patients with complex univentricular cardiac malformations.
- To assess the efficacy and safety of TCPC in improving patient outcomes and functional status.
Main Methods:
- Retrospective analysis of 50 patients who underwent total cavo-pulmonary connections between 1988 and 1997.
- Evaluation of pre- and post-operative oxygen saturation, complications, functional class (NYHA), and long-term outcomes.
Main Results:
- No operative deaths; early complications included cardiac failure, effusions, and arrhythmias.
- Significant improvement in oxygen saturation (76% to 91%, p=0.001) post-surgery.
- At medium-term follow-up (59 months), all patients were in NYHA Classes I and II, with no fatalities. Residual cyanosis and arrhythmias were observed in some patients.
Conclusions:
- Total cavo-pulmonary connections demonstrate satisfactory short- and medium-term results for patients with complex univentricular cardiac malformations.
- TCPC is a viable and effective surgical option for improving hemodynamics and functional status in this patient population.
- Careful patient selection and management of potential complications are crucial for optimal outcomes.
Unlabelled:
The authors report the medium term results of total cavo-pulmonary connections in 50 patients treated between 1988 and 1997.
Population:
the cardiac lesions were single ventricle (n = 27), tricuspid atresia (n = 11), mitral atresia (n = 2), pulmonary atresia with intact septum (n = 2) or more complex lesions (n = 8). The mean age at surgery was 75 +/- 6 months. There were no operative deaths but two early reoperations were required. After surgery, oxygen saturation increased from 76 to 91% (p = 0.001). Early complications included: 11 mild cardiac failures, 19 pericordial or pleural effusions and 6 supraventricular arrhythmias. At medium term (average follow-up of 59 months), there were no fatalities and all were in NYHA Classes I and II. Cyanosis was observed in 12 patients: right-to-left atrial shunt (n = 7), 2 of which were closed percutaneously, shunt from the azygos system to the suprahepatic veins in 5 cases with Kawashima, 2 of which were reoperated, pulmonary arterio-venous fistula (n = 3). Six patients had arrhythmias and 3 had regressive thromboses. At the end of follow-up, 8 patients remained cyanotic, 4 had antiarrhythmic therapy and 2 had mild ventricular dysfunction. In conclusion, the results of total cavo-pulmonary connections are satisfactory at short and medium term and may be proposed for patients with complex univentricular cardiac malformations.