Early Clinical Result of Total Cavopulmonary Connection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Keming , LI Shoujun , ZHANG Yan

Department of Cardiac Surgery,Fu Wai Hospital,Chinese Academy of Medical Sciences &;
Peking Union Medical College,Beijing 100037, P.R.China.;

Corresponding author：

Keywords：

Total cavopulmonary connection; Pleural drainage; Congenital heart disease

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Abstract： Objective To summarize early clinical result of total cavopulmonary connection, and analyze the risk factors contributing to prolonged postoperative recovery. Methods Between February 2009 and August 2010, 58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital. All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle, 10 patients with tricuspid atresia, 4 patients with pulmonary artery atresia, 5 patients with double outlet rightventricle, 1 patient with transposition of great arteries, and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection, and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel. According to their postoperative pleural drainage volume and duration, these 58 patients were divided into a large pleural drainage volume group (17 patients with 10 males and 7 females, mean age of 8.61±6.73 years）that included patients with large volume and long duration of pleural drainage, and a little pleural drainage volume group (41 patients with 15 males and 26 females, mean age of 7.21±4.24 years) . A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups. Results There was no death in hospital period. The average length of hospital stay was 12.30±9.80 d . Average drainage time (18.00±5.50 d versus 5.00±2.20 d , t= -1.967, P ＜ 0.05）, drainage volume (12.30±2.60 ml/(kg·d) versus 2.80±1.70 ml/(kg·d), t=-3.221, P ＜ 0.05), and hospital stay (20.10±7.20 d versus 7.20±1.10 d, t=-2.003, P ＜ 0.05） of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group. Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group (17.42±5.34 mm Hg versus 13.91±5.22 mm Hg，t=-2.073，P ＜ 0.05). Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era. Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.

Citation： YANG Keming,LI Shoujun,ZHANG Yan,et al .. Early Clinical Result of Total Cavopulmonary Connection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(1): 15-18. doi: Copy

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13.	Sughimoto K, Aoki M, Naito Y,et al. Mortality after total cavopulmonary connection in children with the Down syndrome. Am J Cardiol, 2010, 105(2)：865-868.
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1. 　Gewillig M. The Fontan circulation. Heart, 2005, 91(6)：839-846.
2. 　Khambadkone S. The Fontan pathway：What’s down the road? Ann Pediatr Cardiol, 2008, 1(2)：83-92.
3. 　Khairy P, Fernandes SM, Mayer JE Jr, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation, 2008, 117(1)：85-92.
4. 　de Leval MR. The Fontan circulation：What have we learned? What to expect? Pediatr Cardiol, 1998, 19(4)：316-320.
5. 　Diller GP, Giardini A, Dimopoulos K, et al. Predictors of morbidity and mortality in contemporary Fontan patients：results from a multicenter study including cardiopulmonary exercise testing in 321 patients. Eur Heart J, 2010, 31(24)：3073–3083.
6. 　Leyvi G, Bennett HL, Wasnick JD. Pulmonary artery flow after the Fontan procedure are predictive of postoperative complications. J Cardiothorac Vasc Anesth, 2009, 23(1)：54-61.
7. 　Knott-Craig CJ, Danielson GK, Schaff HV, et al. The modified Fontan operation. An analysis of risk factors for early postoperative death or takedown in 702 consecutive patients from one institution. J Thorac Cardiovasc Surg, 1995, 109(6)：1237-1243.
8. 　Gentles TL, Mayer JE, Gauvreau K, et al. Fontan operation in five hundred consecutive patients：factors influencing early and late outcome. J Thorac Cardiovasc Surg, 1997, 114(3)：376-391.
9. 　Yoshimura N, Yamaguchi M, Oshima Y, et al. Risk factors influencing early and late mortality after total cavopulmonary connection. Eur J Cardiothorac Surg, 2001, 20(3)：598-602.
10. 　Hosein RB, Clarke AJ, McGuirk SP, et al. Factors influencing early and late outcome following the Fontan procedure in the current era. The “Two Commandments”? Eur J Cardio-thorac Surg, 2007, 31(3)：344-353.
11. 　Bartz PJ, Driscoll DJ, Dearani JA, et al. Early and late results of the modified Fontan operation for heterotaxy syndrome. J Am Coll Cardiol, 2006, 48(11)：2301-2305.
12. 　Sughimoto K, Aoki M, Naito Y, et al. Novel modification of total cavopulmonary connection for isolated hepatic vein. Ann Thorac Surg, 2009, 88(4)：1367-1370.
13. 　Sughimoto K, Aoki M, Naito Y,et al. Mortality after total cavopulmonary connection in children with the Down syndrome. Am J Cardiol, 2010, 105(2)：865-868.
14. 　Fujii Y, Sano S, Kotani Y, et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg, 2009, 87(2)：562-570.
15. 　Salvin JW, Scheurer MA, Laussen PC, et al. Factors associated with prolonged recovery after the fontan operation. Circulation, 2008,118(suppl 1)：S171–S176.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early Clinical Result of Total Cavopulmonary Connection

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