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What was the impact of the introduction of extracardiac completion for a single center performing total cavopulmonary connections?

Published online by Cambridge University Press:  20 January 2005

Christian Schreiber ,
Martin Kostolny ,
Joachim Weipert ,
Klaus Holper ,
Manfred Vogt ,
Alfred Hager ,
Felix Haas ,
John Hess  and
Rüdiger Lange
Christian Schreiber
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
Martin Kostolny
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
Joachim Weipert
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
Klaus Holper
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
Manfred Vogt
Affiliation:
Clinic of Pediatric Cardiology and Congenital Cardiac Diseases, German Heart Center Munich at the Technical University, Munich, Germany
Alfred Hager
Affiliation:
Clinic of Pediatric Cardiology and Congenital Cardiac Diseases, German Heart Center Munich at the Technical University, Munich, Germany
Felix Haas
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
John Hess
Affiliation:
Clinic of Pediatric Cardiology and Congenital Cardiac Diseases, German Heart Center Munich at the Technical University, Munich, Germany
Rüdiger Lange
Affiliation:
Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany
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Abstract

Background: Creation of an extracardiac cavopulmonary connection has been proposed as a superior alternative to the lateral intracardiac tunnel for the completion of total cavopulmonary connection. Methods and results: We made a retrospective review of our experience with 125 patients undergoing a total cavopulmonary connection between June 1994 and January 2003. Our experience with the extracardiac connection for completion began in 1999. Since 1994, we have constructed an intracardiac tunnel in 50 patients, and an extracardiac connection in 75. Of the total number, 83 had undergone an earlier partial cavopulmonary connection. Additional intracardiac procedures were performed in 43 patients at time of completion, in 25 of those undergoing extracardiac completion, and in 18 of the patients having an intracardiac procedure. The mean size of the tube used for completion was 19 mm. The mean cross-clamp time for placement of the intracardiac tunnel was 77 min, with a median of 80.5 min, and a mean cardiopulmonary bypass time of 139 min, with a median of 131 min. For construction of the extracardiac connection, a mean cross-clamp time in 24 of the 75 patients was 54 min, with a median of 54 min. Mean cardiopulmonary bypass time for all the patients with an extracardiac connection was 100 min, with a median of 88 min. Reoperations were needed in 10 patients, 6 having intracardiac and 4 extracardiac procedures. Of these, 5 were early and 5 late, including one take down. None of the patients died after these interventions. Taken overall, 8 patients died, with 5 early deaths. In the multivariable analysis, cardiopulmonary bypass time of more than 120 min, atrioventricular valvar replacement, and banding of the pulmonary trunk prior to the total cavopulmonary connection, all reached statistical significance for early death, whereas only heterotaxy syndrome remained as the sole risk factor for late death. There was no significant difference in survival between the modifications used. Discussion: Whereas we could not identify any clinical superiority for the extracardiac approach in the short-term, the concept of extracardiac completion has helped to simplify the overall procedure. Longer follow-up will be required to elucidate any potential advantages.

Keywords

Extracardiac cavopulmonary connectionintracardiac cavopulmonary tunneltotal cavopulmonary connection
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 2 , April 2004 , pp. 140 - 147
Copyright
© 2004 Cambridge University Press

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References

Fontan F, Kirklin JW, Fernandez G, Costa F, Naftel DC, Tritto F, Blackstone EH. Outcome after a “perfect” Fontan operation. Circulation 1990; 81: 1520–1536.Google Scholar
Pizarro C, de Leval MR. Surgical variations and flow dynamics in cavopulmonary connections: a historical review. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998; 1: 53–60.Google Scholar
de Leval MR, Kilner P, Gewillig M, Bull C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. J Thorac Cardiovasc Surg 1988; 96: 682–695.Google Scholar
de Leval MR. The Fontan circulation: What have we learned? What to expect? Pediatr Cardiol 1998; 19: 316–320.Google Scholar
Marcelletti CF, Iorio FS, Abella RF. Late results of extracardiac Fontan repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1999; 2: 131–142.Google Scholar
Setty AP, Finuncane K, Skinner JR, Kerr AR. Extracardiac conduit with a limited MAZE procedure for the failing Fontan with atrial tachycardias. Ann Thorac Surg 2002; 74: 1992–1997.Google Scholar
Marcelletti CF, Hanley FL, Mavroudis C, McElhinney DB, Abella RF, Marianeschi SM, Seddio F, Reddy VM, Petrossian E, de la Torre T, Cologrande L, Backer CL, Cipriani A, Iorio FS, Fontan F. Revision of previous Fontan connections to total extracardiac cavopulmonary anstomosis: A multicenter experience. J Thorac Cardiovasc Surg 2000; 119: 340–346.Google Scholar
Vouhe PR. Fontan completion: intracardiac tunnel or extracardiac conduit? J Thorac Cardiovasc Surg 2001; 49: 27–29.Google Scholar
Lardo AC, Webber SA, Friehs I, del Nido PJ, Cape EG. Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections. J Thorac Cardiovasc Surg 1999; 117: 697–704.Google Scholar
Burke RP, Jacobs JP, Ashraf MH, Aldousany A, Chang AC. Extracardiac Fontan operation without cardiopulmonary bypass. Ann Thorac Surg 1997; 63: 1175–1177.Google Scholar
Yetman AT, Drummond-Webb J, Fiser WP, Schmitz ML, Imamura M, Ullah S, Gunselman RJ, Chipman CW, Johnson CE, Van Devanter SH. The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results. Ann Thorac Surg 2002; 74: S1416–S1421.Google Scholar
Mainwaring R, Lamberti JJ. Extracardiac conduit fontan for children with heterotaxy and functionally single ventricle. Cardiol Young 1998; 8: 479–485.Google Scholar
Alexi-Meskishvili V, Ovroutski S, Ewert P, Dähnert I, Berger F, Lange PE, Hetzer R. Optimal conduit size for extracardiac Fontan operation. Eur J Cardio-thorac Surg 2000; 18: 690–695.Google Scholar
Hess J. Long-term problems after cavopulmonary anastomosis: diagnosis and management. Thorac Cardiov Surg 2001; 49: 98–100.Google Scholar
Kreutzer J, Keane JF, Lock JE, Walsh EP, Jonas RA, Castaneda AR, Mayer JE Jr. Conversion of modified Fontan procedure to lateral atrial tunnel cavopulmonary anastomosis. J Thorac Cardiovasc Surg 1996; 111: 1169–1176.Google Scholar
McElhinney DB, Reddy VM, Moore P, Hanley FL. Revision of previous Fontan connections to extracardiac or intraatrial conduit cavopulmonary anastomosis. Ann Thorac Surg 1996; 62: 1276–1282.Google Scholar
Stamm C, Friehs I, Mayer JE Jr, Zurakowski D, Triedman JK, Moran AM, Walsh EP, Lock JE, Jonas RA, Del Nido PJ. Long-term results of the lateral tunnel Fontan operation. J Thorac Cardiovasc Surg 2001; 121: 28–41.Google Scholar
Amodeo A, Galletti L, Marianeschi S, Picardo S, Giannico S, Di Renzi P, Marcelletti C. Extracardiac Fontan operation for complex cardiac anomalies: seven years' experience. J Thorac Cardiovasc Surg 1997; 114: 1020–1031.Google Scholar
Petrossian E, Reddy VM, McElhinney DB, Akkersdijk GP, Moore P, Parry AJ, Thompson LD, Hanley FL. Early results of the extracardiac conduit Fontan operation. J Thorac Cardiovasc Surg 1999; 117: 688–696.Google Scholar
Shirai LK, Rosenthal DN, Reitz BA, Robbins RC, Dubin AM. Arrhythmias and thrombembolic complications after the extracardiac Fontan operation. J Thorac Cardiovasc Surg 1998; 115: 499–505.Google Scholar
Azakie A, McCrindle BW, Van Arsdell G, Benson LN, Coles J, Hamilton R, Freedom RM, Williams WG. Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: impact on outcomes. J Thorac Cardiovasc Surg 2001; 122: 1219–1228.Google Scholar
Cohen MI, Bridges ND, Gaynor JW, Hoffman TM, Wernovsky G, Vetter VL, Spray TL, Rhodes LA. Modifications to the cavopulmonary anastomosis do not eliminate early sinus node dysfunction. J Thorac Cardiovasc Surg 2000; 120: 891–900.Google Scholar
Weipert J, Noebauer C, Schreiber C, Kostolny M, Zrenner B, Wacker A, Hess J, Lange R. Occurrence and management of atrial arrythmia after long-term Fontan circulation. J Thorac Cardiovasc Surg 2004; 127: 457–464.Google Scholar
Gentles TL, Mayer JE Jr, Gauvreau K, Newburger JW, Lock JE, Kupferschmid JP, Burnett J, Jonas RA, Castaneda AR, Wernovsky G. Fontan operation in five hundred consecutice patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg 1997; 114: 376–391.Google Scholar
McElhinney DB, Petrossian E, Reddy VM, Hanley FL. Extracardiac conduit Fontan procedure without cardiopulmonary bypass. Ann Thorac Surg 1998; 66: 1826–1828.Google Scholar
Uemura H, Yagihara T, Kawahira Y, Yoshikawa Y, Kitamura S. Total cavopulmonary connection in children with body weight less than 10 kg. Eur J Cardio-thorac Surg 2000; 17: 543–549.Google Scholar
Tokunaga S, Kado H, Imoto Y, Masuda M, Shiokawa Y, Fukae K, Fusazaki N, Ishikawa S, Yasui H. Total cavopulmonary connection with an extracardiac conduit: experience with 100 patients. Ann Thorac Surg 2002; 73: 76–80.Google Scholar
Thompson LD, Petrossian E, McElhinney DB, Abrikosova NA, Moore P, Reddy VM, Hanley FL. Is it necessary to routinely fenestrate an extracardiac fontan? J Am Coll Cardiol 1999; 34: 539–544.Google Scholar
Atik E, Ikari NM, Martins TC, Marcial M-B. Fontan operation and the cavopulmonary technique. Immediate and late results according to the presence of atrial fenestration. Arq Bras Cardiol 2002; 78: 162–166.Google Scholar
Jahangiri M, Kreutzer J, Zurakowski D, Bacha E, Jonas RA. Evaluation of hemostatic and coagulation factor abnormalities in patients undergoing th Fontan operation. J Thorac Cardiovasc Surg 2000; 120: 778–782.Google Scholar
Seipelt RG, Frank A, Vazquez-Jimenez JF, Hanrath P, von Bernuth G, Messmer BJ, Muhler EG. Thromboembolic complications after Fontan procedures: comparison of different therapeutic approaches. Ann Thorac Surg 2002; 74: 556–562.Google Scholar
Sugimoto S, Takagi N, Hachiro Y, Abe T. High frequency of arrythmias after Fontan operation indicates earlier anticoagulant therapy. Int J Cardiol 2001; 78: 33–39.Google Scholar
Balling G, Vogt M, Kaemmerer H, Eicken A, Meisner H, Hess J. Intracardiac thrombus formation after the Fontan operation. J Thorac Cardiovasc Surg 2000; 119: 745–752.Google Scholar
Coon PD, Rychik J, Novello RT, Ro PS, Gaynor JW, Spray TL. Thrombus formation after the Fontan operation. Ann Thorac Surg 2001; 71: 1990–1994.Google Scholar
Jacobs ML, Pourmoghadam KK, Geary EM, Reyes AT, Madan N, McGrath LB, Moore JW. Fontan's operation: is aspirin enough? Is coumadin too much? Ann Thorac Surg 2002; 73: 64–68.Google Scholar