Extracardiac Conduit Total Cavopulmonary Connection for Surgical Treatment of Complex Congenital Heart Diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANTao , YUHao , WANGXian-yue , LINXi , PENGXiao-bo , BISheng-hui , MEILu-gang , MATao , WANGXiao-wu ,  ZHANGWei-da

Department of Cardiac Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, P. R. China;

Corresponding author：

ZHANGWei-da, Email: xzwkzx@163.com

Keywords：

Total cavopulmonary connection; Extracardiac conduit; Congenital heart disease

DOI：

10.7507/1007-4848.20140085

Video：

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Objective To summarize clinical experience and outcomes of extracardiac conduit total cavopulmonary connection (TCPC)for surgical treatment of complex congenital heart diseases. Methods Clinical data of 52 patients who underwent extracardiac conduit TCPC from September 2006 to December 2012 in Department of Cardiac Surgery, Guangzhou General Hospital of Guangzhou Military Command were retrospectively analyzed. There were 12 patients who received one-stage extracardiac conduit TCPC. There were 40 patients who received two-staged extracardiac conduit TCPC after bidirectional Glenn procedure. Clinical data of all the patients were analyzed. Mortality, morbidity, length of hospital stay and intensive care unit (ICU)stay, mechanical ventilation time, change of arterial oxygen saturation (SaO₂)were compared between the 2 groups. Results Two patients (3.8%)died postoperatively including 1 patient with severe low cardiac output syndrome and another patient with multiple organ dysfunction syndrome. Fifty patients were discharged successfully. Mechanical ventilation time, length of ICU stay and hospital stay of the 40 patients who received two-stage extracardiac conduit TCPC were significantly shorter than those of the 12 patients who received one-stage extracardiac conduit TCPC. There was no statistical difference in postoperative morbidity, SaO₂ (two-staged vs. one-staged:93%±3% vs. 94%±3%)or mortality (two-staged vs. one-staged:2.5% vs.8.3%)between the 2 groups (P > 0.05). Forty-five patients (90%)were followed up for 6-52 months, and there was no death during follow-up. At 3 months after TCPC, all the patients had heart function of class I or II, and echocardiography showed patent cavopulmonary anastomosis. Conclusion Extracardiac conduit TCPC is a simple procedure, can produce more physiological hemodynamic results, and can be performed for patients who cannot undergo biventricle procedure. Compared with one-stage extracardiac conduit TCPC, two-staged extracardiac conduit TCPC has wider surgical indications, can produce better postoperative recovery, and is easier to perform.

Citation： YANTao, YUHao, WANGXian-yue, LINXi, PENGXiao-bo, BISheng-hui, MEILu-gang, MATao, WANGXiao-wu, ZHANGWei-da. Extracardiac Conduit Total Cavopulmonary Connection for Surgical Treatment of Complex Congenital Heart Diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 302-305. doi: 10.7507/1007-4848.20140085 Copy

1.	Fu S, Valeske K, Muller M, et al. Total cavopulmonary connection:lateral tunnel anastomosis or extracardiac conduit?--an analysis of 114 consecutive patients. Chin Med Sci J, 2009, 24 (2):76-80.
2.	刘维永, 俞世强.全腔静脉-肺动脉连接术的回顾与展望.中国胸心血管外科临床杂志, 2011, 18 (2):149-152.
3.	de Leval MR, Kilner P, Gewillig M, et al. Total cavopulmonary connection:a logical alternative to atriopulmonary connection for complex Fontan operations.Experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96 (5):682-695.
4.	Marcelletti C, Corno A, Giannico S, et al. Inferior vena cava-pulmonary artery extracardiac conduit.A new form of right heart bypass. J Thorac Cardiovasc Surg, 1990, 100 (2):228-232.
5.	Aboulhosn J, Williams R, Shivkumar K, et al. Arrhythmia recurrence in adult patients with single ventricle physiology following surgical Fontan conversion. Congenit Heart Dis, 2010, 5 (5):430-434.
6.	杨克明, 李守军, 张岩, 等.全腔静脉-肺动脉连接术早期临床结果.中国胸心血管外科临床杂志, 2012, 19 (1):15-18.
7.	Nakayama Y, Hiramatsu T, Iwata Y, et al. Surgical results for func-tional univentricular heart with total anomalous pulmonary venous connection over a 25-year experience. Ann Thorac Surg, 2012, 93 (2):606-613.
8.	孙国成, 郑奇军, 易定华, 等.应用系列改良Fontan手术治疗复杂先天性心脏病.中国胸心血管外科临床杂志, 2008, 15 (6):406-410.
9.	Fujii Y, Kotani Y, Takagaki M, et al. Growth of the lateral tunnel in patients who underwent a total cavopulmonary connection at less than 5 years of age. Eur J Cardiothorac Surg, 2010, 38 (1):66-70.
10.	Podzolkov VP, Zelenikin MM, Yurlov IA, et al. Immediate results of bidirectional cavopulmonary anastomosis and Fontan operations in adults. Interact Cardiovasc Thorac Surg, 2011, 12 (2):141-145.
11.	Odenwald T, Quail MA, Giardini A, et al. Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection. Heart, 2012, 98 (12):934-940.
12.	Lemler MS, Ramaciotti C, Stromberg D, et al. The extracardiac lateral tunnel Fontan, constructed with bovine pericardium:comparison with the extracardiac conduit Fontan. Am Heart J, 2006, 151 (4):928-933.
13.	Voges I, Jerosch-Herold M, Hart C, et al. Anatomical and functional assessment of the intra-atrial lateral tunnel in the Fontan circulation. Eur J Cardiothorac Surg, 2013, 44 (3):462-467.
14.	Robbers-Visser D, Miedema M, Nijveld A, et al. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg, 2010, 37 (4):934-941.
15.	Muller J, Christov F, Schreiber C, et al. Exercise capacity, quality of Life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. Eur Heart J, 2009, 30 (23):2915-2920.
16.	Choussat A, Baudet E.[Outcome of surgically treated congenital heart diseases].[Article in French] Arch Mal Coeur Vaiss, 1990, 83 (5):607-609.
17.	Sharma R, Iyer KS, Airan B, et al. Univentricular repair. Early and midterm results. J Thorac Cardiovasc Surg, 1995, 110 (6):1692-1701.
18.	Roubertie F, Peltan J, Henaine R, et al. Early to midterm results of total cavopulmonary connection in adult patients. Ann Thorac Surg, 2013, 95 (3):941-947.
19.	王亮君, 郑景浩, 黄继红. Fontan循环.国际心血管病杂志, 2011, 38 (5):297-300.
20.	Adachi I, Yagihara T, Kagisaki K, et al. Preoperative small pulm-onary artery did not affect the midterm results of Fontan operation. Eur J Cardiothorac Surg, 2007, 32 (1):156-162.
21.	Fontan F, Kirklin JW, Fernandez G, et al. Outcome after a "perfect" Fontan operation. Circulation, 1990, 81 (5):1520-1536.
22.	Shiraishi S, Uemura H, Kagisaki K, et al. Long-term results of total cavopulmonary connection with low ejection fraction. Gen Thorac Cardiovasc Surg, 2011, 59 (10):686-692.
23.	Ota N, Fujimoto Y, Murata M, et al. Impact of postoperative hemod-ynamics in patients with functional single ventricle undergoing Fontan completion before weighing 10 kg. Ann Thorac Surg, 2012, 94 (5):1570-1577.
24.	Chen H, Hong H, Zhu Z, et al. Extracardiac fontan with direct cavo-pulmonary connections:midterm results. Eur J Cardiothorac Surg, 2013, 43 (2):318-323.
25.	Francois K, Bove T, Panzer J, et al. Univentricular heart and Fontan staging:analysis of factors impacting on body growth. Eur J Cardiothorac Surg, 2012, 41 (6):e139-e145.

1. Fu S, Valeske K, Muller M, et al. Total cavopulmonary connection:lateral tunnel anastomosis or extracardiac conduit?--an analysis of 114 consecutive patients. Chin Med Sci J, 2009, 24 (2):76-80.
2. 刘维永, 俞世强.全腔静脉-肺动脉连接术的回顾与展望.中国胸心血管外科临床杂志, 2011, 18 (2):149-152.
3. de Leval MR, Kilner P, Gewillig M, et al. Total cavopulmonary connection:a logical alternative to atriopulmonary connection for complex Fontan operations.Experimental studies and early clinical experience. J Thorac Cardiovasc Surg, 1988, 96 (5):682-695.
4. Marcelletti C, Corno A, Giannico S, et al. Inferior vena cava-pulmonary artery extracardiac conduit.A new form of right heart bypass. J Thorac Cardiovasc Surg, 1990, 100 (2):228-232.
5. Aboulhosn J, Williams R, Shivkumar K, et al. Arrhythmia recurrence in adult patients with single ventricle physiology following surgical Fontan conversion. Congenit Heart Dis, 2010, 5 (5):430-434.
6. 杨克明, 李守军, 张岩, 等.全腔静脉-肺动脉连接术早期临床结果.中国胸心血管外科临床杂志, 2012, 19 (1):15-18.
7. Nakayama Y, Hiramatsu T, Iwata Y, et al. Surgical results for func-tional univentricular heart with total anomalous pulmonary venous connection over a 25-year experience. Ann Thorac Surg, 2012, 93 (2):606-613.
8. 孙国成, 郑奇军, 易定华, 等.应用系列改良Fontan手术治疗复杂先天性心脏病.中国胸心血管外科临床杂志, 2008, 15 (6):406-410.
9. Fujii Y, Kotani Y, Takagaki M, et al. Growth of the lateral tunnel in patients who underwent a total cavopulmonary connection at less than 5 years of age. Eur J Cardiothorac Surg, 2010, 38 (1):66-70.
10. Podzolkov VP, Zelenikin MM, Yurlov IA, et al. Immediate results of bidirectional cavopulmonary anastomosis and Fontan operations in adults. Interact Cardiovasc Thorac Surg, 2011, 12 (2):141-145.
11. Odenwald T, Quail MA, Giardini A, et al. Systemic to pulmonary collateral blood flow influences early outcomes following the total cavopulmonary connection. Heart, 2012, 98 (12):934-940.
12. Lemler MS, Ramaciotti C, Stromberg D, et al. The extracardiac lateral tunnel Fontan, constructed with bovine pericardium:comparison with the extracardiac conduit Fontan. Am Heart J, 2006, 151 (4):928-933.
13. Voges I, Jerosch-Herold M, Hart C, et al. Anatomical and functional assessment of the intra-atrial lateral tunnel in the Fontan circulation. Eur J Cardiothorac Surg, 2013, 44 (3):462-467.
14. Robbers-Visser D, Miedema M, Nijveld A, et al. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg, 2010, 37 (4):934-941.
15. Muller J, Christov F, Schreiber C, et al. Exercise capacity, quality of Life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. Eur Heart J, 2009, 30 (23):2915-2920.
16. Choussat A, Baudet E.[Outcome of surgically treated congenital heart diseases].[Article in French] Arch Mal Coeur Vaiss, 1990, 83 (5):607-609.
17. Sharma R, Iyer KS, Airan B, et al. Univentricular repair. Early and midterm results. J Thorac Cardiovasc Surg, 1995, 110 (6):1692-1701.
18. Roubertie F, Peltan J, Henaine R, et al. Early to midterm results of total cavopulmonary connection in adult patients. Ann Thorac Surg, 2013, 95 (3):941-947.
19. 王亮君, 郑景浩, 黄继红. Fontan循环.国际心血管病杂志, 2011, 38 (5):297-300.
20. Adachi I, Yagihara T, Kagisaki K, et al. Preoperative small pulm-onary artery did not affect the midterm results of Fontan operation. Eur J Cardiothorac Surg, 2007, 32 (1):156-162.
21. Fontan F, Kirklin JW, Fernandez G, et al. Outcome after a "perfect" Fontan operation. Circulation, 1990, 81 (5):1520-1536.
22. Shiraishi S, Uemura H, Kagisaki K, et al. Long-term results of total cavopulmonary connection with low ejection fraction. Gen Thorac Cardiovasc Surg, 2011, 59 (10):686-692.
23. Ota N, Fujimoto Y, Murata M, et al. Impact of postoperative hemod-ynamics in patients with functional single ventricle undergoing Fontan completion before weighing 10 kg. Ann Thorac Surg, 2012, 94 (5):1570-1577.
24. Chen H, Hong H, Zhu Z, et al. Extracardiac fontan with direct cavo-pulmonary connections:midterm results. Eur J Cardiothorac Surg, 2013, 43 (2):318-323.
25. Francois K, Bove T, Panzer J, et al. Univentricular heart and Fontan staging:analysis of factors impacting on body growth. Eur J Cardiothorac Surg, 2012, 41 (6):e139-e145.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Extracardiac Conduit Total Cavopulmonary Connection for Surgical Treatment of Complex Congenital Heart Diseases

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