HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshihiro Oshima Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yoshimura, N. Articles by Kido, S. Search for Related Content PubMed PubMed Citation Articles by Yoshimura, N. Articles by Kido, S. Related Collections Congenital - cyanotic

Eur J Cardiothorac Surg 2001;20:598-602
© 2001 Elsevier Science NL

Risk factors influencing early and late mortality after total cavopulmonary connection

^a Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Japan
^b Department of Cardiology, Kobe Children's Hospital, Kobe, Japan

Received 23 October 2000; received in revised form 21 May 2001; accepted 13 June 2001.

Corresponding author. Department of Cardiothoracic Surgery, Kobe Children’s Hospital, 1-1-1, Takakura-dai, Suma-Ku, Kobe, 654-0081, Japan. Tel.: +81-78-732-6961; fax: +81-78-735-0910
e-mail: y-naoki{at}za2.so-net.ne.jp

Objective: Among the later modifications of the Fontan type procedure, a significant alteration was introduced by de Leval and associates when they described the total cavopulmonary connection (TCPC). Although current results of TCPC have encouraged us to extend this procedure to high risk patients, risk factors influencing surgical outcome after TCPC have not been evaluated. We review our experiences with TCPC to identify which risk factors may have had a considerable impact on the outcome of patients undergoing TCPC and to clarify selection criteria of high-risk Fontan candidates for TCPC. Patients and methods: We retrospectively reviewed the medical and surgical records of all 76 patients who underwent TCPC between July 1988 and August 2000. A cross-sectional review of these patients was undertaken. Results: There were eight early deaths and four late deaths. In a Fisher's exact test, the following variables were associated with an increased early mortality after TCPC: systemic ventricular morphology (right ventricle), ejection fraction of the systemic ventricle less than 60%, and prolonged cardiopulmonary bypass time (240 min or longer). The log-rank test demonstrated that heterotaxy syndrome, moderate to severe atrioventricular valve regurgitation, prolonged cardiopulmonary bypass time (240 min or longer), and prolonged aortic cross clamp time (70 min or longer) were associated with late mortality after TCPC. Six deaths occurred in eight (75%) patients who had six or more risk factors, whereas six deaths (9%) occurred in those who had five or fewer. Conclusions: Patients with complex cardiac anomalies who have six or more risk factors should be excluded from TCPC candidates.

Key Words: Fontan operation • Total cavopulmonary connection • Risk factors

This article has been cited by other articles:

				Y. Kotani, S. Kasahara, Y. Fujii, K. Yoshizumi, Y. Oshima, S.-i. Otsuki, T. Akagi, and S. Sano Clinical outcome of the Fontan operation in patients with impaired ventricular function Eur. J. Cardiothorac. Surg., October 1, 2009; 36(4): 683 - 687. [Abstract] [Full Text] [PDF]

				F. Kerendi, Z. B. Kramer, W. T. Mahle, B. E. Kogon, K. R. Kanter, and P. M. Kirshbom Perioperative risks and outcomes of atrioventricular valve surgery in conjunction with Fontan procedure. Ann. Thorac. Surg., May 1, 2009; 87(5): 1484 - 1488. [Abstract] [Full Text] [PDF]

				M. L. Jacobs, G. J. Pelletier, K. K. Pourmoghadam, C. I. Mesia, N. Madan, H. Stern, R. Schwartz, and J. D. Murphy Protocols associated with no mortality in 100 consecutive Fontan procedures Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 626 - 632. [Abstract] [Full Text] [PDF]

				A. M.E. Koch, S. Zink, H. Singer, and S. Dittrich B-type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection Eur J Heart Fail, January 1, 2008; 10(1): 60 - 62. [Abstract] [Full Text] [PDF]

				J. R. Lee, J. Kwak, K. C. Kim, S. K. Min, W.-H. Kim, Y. J. Kim, and J. R. Rho Comparison of lateral tunnel and extracardiac conduit Fontan procedure Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 328 - 330. [Abstract] [Full Text] [PDF]

				J.-Y. Hsu, J.-K. Wang, M.-T. Lin, E.-T. Wu, S.-N. Chiu, C.-A. Chen, H.-C. Lue, and M.-H. Wu Clinical implications of major aortopulmonary collateral arteries in patients with right isomerism. Ann. Thorac. Surg., July 1, 2006; 82(1): 153 - 157. [Abstract] [Full Text] [PDF]

				M. Yoshida, M. Yamaguchi, N. Yoshimura, H. Murakami, H. Matsuhisa, and Y. Okita Appropriate Additional Pulmonary Blood Flow at the Bidirectional Glenn Procedure is Useful for Completion of Total Cavopulmonary Connection Ann. Thorac. Surg., September 1, 2005; 80(3): 976 - 981. [Abstract] [Full Text] [PDF]

				C. Mavroudis, R. D. Stewart, C. L. Backer, B. J. Deal, L. Young, and W. H. Franklin Atrioventricular Valve Procedures with Repeat Fontan Operations: Influence of Valve Pathology, Ventricular Function, and Arrhythmias on Outcome Ann. Thorac. Surg., July 1, 2005; 80(1): 29 - 36. [Abstract] [Full Text] [PDF]

				N. Yoshimura, M. Yamaguchi, S. Oka, M. Yoshida, and H. Murakami Pulmonary Artery Banding Still Has an Important Role in the Treatment of Congenital Heart Disease Ann. Thorac. Surg., April 1, 2005; 79(4): 1463 - 1463. [Full Text] [PDF]

				S. P. Kumar, C. S. Rubinstein, J. M. Simsic, A. B. Taylor, J. P. Saul, and S. M. Bradley Lateral tunnel versus extracardiac conduit fontan procedure: a concurrent comparison Ann. Thorac. Surg., November 1, 2003; 76(5): 1389 - 1397. [Abstract] [Full Text] [PDF]