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): David S. Winlaw Stephen M. Langley John G. Wright William J. Brawn David J. Barron Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McGuirk, S. P. Articles by Barron, D. J. Search for Related Content PubMed PubMed Citation Articles by McGuirk, S. P. Articles by Barron, D. J. Related Collections Congenital - acyanotic Congenital - cyanotic

Eur J Cardiothorac Surg 2003;24:37-46
© 2003 Elsevier Science NL

The impact of ventricular morphology on midterm outcome following completion total cavopulmonary connection

^a Department of Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
^b Department of Cardiology, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK

Received 16 January 2003; received in revised form 14 March 2003; accepted 19 March 2003.

^* Corresponding author. Tel.: +44-121-333-9435; fax: +44-121-333-9441
e-mail: david.barron{at}bhamchildrens.wmids.nhs.uk

Objective: This study was undertaken to compare the early and midterm outcome following completion total cavopulmonary connection (TCPC) in patients with a single functional ventricle of left or right morphology. Methods: Between August 1996 and July 2001, 103 patients underwent completion TCPC following an interim superior cavopulmonary connection. The single functional ventricle was of left (n=44, 42%) or right ventricular morphology (n=59, 58%). The TCPC was performed using an extracardiac conduit (n=84, 82%) or a lateral atrial tunnel (n=19, 18%), and was fenestrated in 53 patients (51%). Outcomes studied included duration of pleural effusions and in-patient hospitalisation; early mortality, reoperation and reintervention; actuarial survival, freedom from reoperation and reintervention; and current functional status. These were assessed according to a series of preoperative, operative and postoperative variables. Follow-up was complete with a median interval of 17 months (range, 21 days–5.2 years). Results: Early mortality was 1.9% (n=2) and one other patient required takedown of the Fontan circulation. There was one late death. Five-year survival with a Fontan circulation (±1 SEM) was 95.6±2.5%. Forty-two patients (41%) had prolonged pleural drainage (14 days) and 41 patients (40%) had a prolonged hospital stay. Five-year freedom from reoperation and reintervention (±1 SEM) were 92.2±5.0 and 73.4±6.0%, respectively. The Fontan procedure was associated with an improved functional class (P<0.005) and all current survivors (n=99) are in either New York Heart Association classes I or II. Multivariate analysis identified left atrial isomerism as the single risk factor for death (P<0.05). Independent risk factors for prolonged hospital stay included a morphologic right ventricle (P<0.05), increased postoperative pulmonary artery pressures (P<0.005) and an unfenestrated Fontan procedure (P<0.01). Conclusions: In this contemporary series, the modified Fontan procedure was characterised by low early mortality, excellent midterm survival, and improved functional class independent of the morphology of the single functional ventricle. Nevertheless, a morphologic right ventricle was a risk factor for prolonged in-patient hospitalisation and may yet influence long term survival.

Key Words: Fontan procedure • Total cavopulmonary connection • Risk factors • Heart defects • Congenital • Paediatrics

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]

				J. S. Tweddell, M. Nersesian, K. A. Mussatto, M. Nugent, P. Simpson, M. E. Mitchell, N. S. Ghanayem, A. N. Pelech, R. Marla, and G. M. Hoffman Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann. Thorac. Surg., October 1, 2009; 88(4): 1291 - 1299. [Abstract] [Full Text] [PDF]

				S. Shiraishi, T. Yagihara, K. Kagisaki, I. Hagino, H. Ohuchi, J. Kobayashi, and S. Kitamura Impact of age at fontan completion on postoperative hemodynamics and long-term aerobic exercise capacity in patients with dominant left ventricle. Ann. Thorac. Surg., February 1, 2009; 87(2): 555 - 561. [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]

				P. Khairy, S. M. Fernandes, J. E. Mayer Jr, J. K. Triedman, E. P. Walsh, J. E. Lock, and M. J. Landzberg Long-Term Survival, Modes of Death, and Predictors of Mortality in Patients With Fontan Surgery Circulation, January 1, 2008; 117(1): 85 - 92. [Abstract] [Full Text] [PDF]

				C. Schreiber, J. Horer, M. Vogt, J. Cleuziou, Z. Prodan, and R. Lange Nonfenestrated Extracardiac Total Cavopulmonary Connection in 132 Consecutive Patients Ann. Thorac. Surg., September 1, 2007; 84(3): 894 - 899. [Abstract] [Full Text] [PDF]

				R. B.M. Hosein, A. J.B. Clarke, S. P. McGuirk, M. Griselli, O. Stumper, J. V. De Giovanni, D. J. Barron, and W. J. Brawn Factors influencing early and late outcome following the Fontan procedure in the current era. The 'Two Commandments'? Eur. J. Cardiothorac. Surg., March 1, 2007; 31(3): 344 - 353. [Abstract] [Full Text] [PDF]

				C. Pizarro, T. Mroczek, S. S. Gidding, J. D. Murphy, and W. I. Norwood Fontan Completion in Infants Ann. Thorac. Surg., June 1, 2006; 81(6): 2243 - 2249. [Abstract] [Full Text] [PDF]

				S P McGuirk, M Griselli, O F Stumper, E M Rumball, P Miller, R Dhillon, J V de Giovanni, J G Wright, D J Barron, and W J Brawn Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience Heart, March 1, 2006; 92(3): 364 - 370. [Abstract] [Full Text] [PDF]

				K. Pekkan, H. D. Kitajima, D. de Zelicourt, J. M. Forbess, W. J. Parks, M. A. Fogel, S. Sharma, K. R. Kanter, D. Frakes, and A. P. Yoganathan Total Cavopulmonary Connection Flow With Functional Left Pulmonary Artery Stenosis: Angioplasty and Fenestration In Vitro Circulation, November 22, 2005; 112(21): 3264 - 3271. [Abstract] [Full Text] [PDF]

				A. J. B. Clarke, S. Kasahara, D. R. Andrews, S. G. Cooper, I. A. Nicholson, R. B. Chard, G. R. Nunn, and D. S. Winlaw Mid-Term results for double inlet left ventricle and similar morphologies: timing of Damus-Kaye-Stansel Ann. Thorac. Surg., August 1, 2004; 78(2): 650 - 657. [Abstract] [Full Text] [PDF]