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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

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