Early Results of Total Cavopulmonary Connection by Extracardiac Conduit in Adults with Complex Congenital Heart Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANGYan-bo , MENGYan-hai , YANGKe-ming , LIShou-jun , CHANGShuo , HUANGHai-bo , SHIChen , YANGQiu-lan , LIUZi-na

Department of ICU Surgery, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

ZHANGYan-bo, Email: yanbozhang@126.com

Keywords：

Total cavopulmonary connection; Extracardiac conduit; Congenital heart disease; Adult

DOI：

10.7507/1007-4848.20150205

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Objective To summerize the early results of total cavopulmonary connection (TCPC) procedure with an extracardiac conduit in adults with congenital heart disease, and assess risk factors for postoperative delayed recovery in ICU. Methods We retrospectively analyzed the clinical data of 20 adult patients underwent TCPC operation with extracardiac conduit in Fu Wai Hospital between January 2012 and December 2014. There were 14 female and 6 male patients at age of 16 to 33 (20.45±4.33) years. Results There was no hospital mortality. The time of ICU stay was 4.4±1.7 days. And time of hospital stay was 32.5±21.6 days. Morbidities included prolonged pleural effusion lasting more than 7 days in 12 patients (60.0%), new arrhythmias in 3 patients (15.0%), reexploration for bleeding in 3 patients (15.0%), surgical wound poor healing in 1 patient (5.0%). Dopamine and calcium were used in all the patients in the ICU, epinephrine in 18 patients, milrinone in 11 patients. Risk factors for postoperative delayed recovery in ICU were preoperative arrhythmias (P=0.02), cardiopulmonary bypass time longer than 120 min (P=0.04), plasma applications more than 2 000 ml (P=0.01), absence of fenestration (P=0.04), and pleural effusion lasting longer than 7 days (P=0.04). Conclusion The TCPC procedure with an extracardiac conduit can be performed in adults with encouraged early results. Actively vasoactive drugs to maintain circulation early in ICU has good results for the patient's recovery.

Citation： ZHANGYan-bo, MENGYan-hai, YANGKe-ming, LIShou-jun, CHANGShuo, HUANGHai-bo, SHIChen, YANGQiu-lan, LIUZi-na. Early Results of Total Cavopulmonary Connection by Extracardiac Conduit in Adults with Complex Congenital Heart Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 816-820. doi: 10.7507/1007-4848.20150205 Copy

1.	Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3):240-248.
2.	刘维永, 俞世强. 全腔静脉一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.	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.
4.	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.
5.	Lee MG, Brizard CP, Galati JC, et al. Outcomes of patients born with single-ventricle physiology and aortic arch obstruction:The 26-year melbourne experience. J Thorac Cardiovasc Surg, 2014, 148(1):194-201.
6.	Fujii Y, Sano S, Kotani Y, et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg, 2009, 87(2):562-570.
7.	Mavroudis C, Deal BJ, Backer CL, et al. J. Maxwell chamberlain memorial paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery:surgical lessons and outcomes. Ann Thorac Surg, 2007, 84(5):1457-1465.
8.	岑坚正, 庄建, 陈寄梅, 等. 全腔静脉一肺动脉连接术工期或分期生理矫治复杂先天性心脏病. 中华小儿外科杂志, 2010, 31(11):814-818.
9.	Bapat V, Allen D, Young C, et al. Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg, 2005, 20(3):212-217.
10.	Angeli E, Pace Napoleone C, Balducci A, et al. Natural and modified history of single-ventricle physiology in adult patients. Eur J Cardiothorac Surg, 2012, 42(6):996-1002.
11.	Girod DA, Fontan F, Deville C, et al. Long-term results after the fontan operation for tricuspid atresia. Circulation, 1987, 75(3):605-610.
12.	Talwar S, Rajashekar P, Muthukkumaran S, et al. Alternative approach for repair of total anomalous pulmonary venous connection to the coronary sinus at the time of extracardiac total cavopulmonary connection. J Card Surg, 2014, 29(3):403-405.
13.	Driscoll DJ, Offord KP, Feldt RH, et al. Five-to fifteen-year follow-up after Fontan operation. Circulation, 1992, 85(2):469-496.
14.	Humes RA, Mair DD, Porter CB, et al. Results of the modified Fontan operation in adults. Am J Cardiol, 1988, 61(8):602-604.
15.	Gates RN, Laks H, Drinkwater DC, Jr., et al. The Fontan procedure in adults. Ann Thorac Surg, 1997, 63(4):1085-1090.
16.	Veldtman GR, Nishimoto A, Siu S, et al. The Fontan procedure in adults. Heart, 2001, 86(3):330-335.
17.	Valente AM, Lewis M, Vaziri SM, et al. Outcomes of adolescents and adults undergoing primary Fontan procedure. Am J Cardiol, 2013, 112(12):1938-1942.
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.	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.
20.	Gregori F Jr, Thomson M, Menescal RJ, et al. Technical modification for total cavopulmonary connection in a 9-year-old girl:A 20-year postoperative approach. Rev Bras Cir Cardiovasc, 2013, 28(2):302-305.
21.	Hong H, Menon PG, Zhang H, et al. Postsurgical comparison of pulsatile hemodynamics in five unique total cavopulmonary connections:Identifying ideal connection strategies. Ann Thorac Surg, 2013, 96(4):1398-1404.
22.	Cohen SB, Ginde S, Bartz PJ, et al. Extracardiac complications in adults with congenital heart disease. Congenit Heart Dis, 2013, 8(5):370-380.
23.	d'Udekem Y, Iyengar AJ, Cochrane AD, et al. The fontan procedure:Contemporary techniques have improved long-term outcomes. Circulation, 2007, 116(11 Suppl):I157-164.
24.	Gentles TL, Mayer JE Jr, Gauvreau K, et al. Fontan operation in five hundred consecutive patients:Factors influencing early and late outcome. J Thorac Cardiovasc Surg, 1997, 114(3):376-391.
25.	Schuuring MJ, Vis JC, van Dijk AP, et al. Impact of bosentan on exercise capacity in adults after the Fontan procedure:A randomized controlled trial. Eur J Heart Fail, 2013, 15(6):690-698.
26.	张雅娟, 闫军, 李守军, 等. 延长Fontan类手术患者住院时间的危险因素分析. 中国胸心血管外科临床杂志, 2014, 21(3):312-317.

1. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax, 1971, 26(3):240-248.
2. 刘维永, 俞世强. 全腔静脉一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. 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.
4. 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.
5. Lee MG, Brizard CP, Galati JC, et al. Outcomes of patients born with single-ventricle physiology and aortic arch obstruction:The 26-year melbourne experience. J Thorac Cardiovasc Surg, 2014, 148(1):194-201.
6. Fujii Y, Sano S, Kotani Y, et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg, 2009, 87(2):562-570.
7. Mavroudis C, Deal BJ, Backer CL, et al. J. Maxwell chamberlain memorial paper for congenital heart surgery. 111 Fontan conversions with arrhythmia surgery:surgical lessons and outcomes. Ann Thorac Surg, 2007, 84(5):1457-1465.
8. 岑坚正, 庄建, 陈寄梅, 等. 全腔静脉一肺动脉连接术工期或分期生理矫治复杂先天性心脏病. 中华小儿外科杂志, 2010, 31(11):814-818.
9. Bapat V, Allen D, Young C, et al. Survival and quality of life after cardiac surgery complicated by prolonged intensive care. J Card Surg, 2005, 20(3):212-217.
10. Angeli E, Pace Napoleone C, Balducci A, et al. Natural and modified history of single-ventricle physiology in adult patients. Eur J Cardiothorac Surg, 2012, 42(6):996-1002.
11. Girod DA, Fontan F, Deville C, et al. Long-term results after the fontan operation for tricuspid atresia. Circulation, 1987, 75(3):605-610.
12. Talwar S, Rajashekar P, Muthukkumaran S, et al. Alternative approach for repair of total anomalous pulmonary venous connection to the coronary sinus at the time of extracardiac total cavopulmonary connection. J Card Surg, 2014, 29(3):403-405.
13. Driscoll DJ, Offord KP, Feldt RH, et al. Five-to fifteen-year follow-up after Fontan operation. Circulation, 1992, 85(2):469-496.
14. Humes RA, Mair DD, Porter CB, et al. Results of the modified Fontan operation in adults. Am J Cardiol, 1988, 61(8):602-604.
15. Gates RN, Laks H, Drinkwater DC, Jr., et al. The Fontan procedure in adults. Ann Thorac Surg, 1997, 63(4):1085-1090.
16. Veldtman GR, Nishimoto A, Siu S, et al. The Fontan procedure in adults. Heart, 2001, 86(3):330-335.
17. Valente AM, Lewis M, Vaziri SM, et al. Outcomes of adolescents and adults undergoing primary Fontan procedure. Am J Cardiol, 2013, 112(12):1938-1942.
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. 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.
20. Gregori F Jr, Thomson M, Menescal RJ, et al. Technical modification for total cavopulmonary connection in a 9-year-old girl:A 20-year postoperative approach. Rev Bras Cir Cardiovasc, 2013, 28(2):302-305.
21. Hong H, Menon PG, Zhang H, et al. Postsurgical comparison of pulsatile hemodynamics in five unique total cavopulmonary connections:Identifying ideal connection strategies. Ann Thorac Surg, 2013, 96(4):1398-1404.
22. Cohen SB, Ginde S, Bartz PJ, et al. Extracardiac complications in adults with congenital heart disease. Congenit Heart Dis, 2013, 8(5):370-380.
23. d'Udekem Y, Iyengar AJ, Cochrane AD, et al. The fontan procedure:Contemporary techniques have improved long-term outcomes. Circulation, 2007, 116(11 Suppl):I157-164.
24. Gentles TL, Mayer JE Jr, Gauvreau K, et al. Fontan operation in five hundred consecutive patients:Factors influencing early and late outcome. J Thorac Cardiovasc Surg, 1997, 114(3):376-391.
25. Schuuring MJ, Vis JC, van Dijk AP, et al. Impact of bosentan on exercise capacity in adults after the Fontan procedure:A randomized controlled trial. Eur J Heart Fail, 2013, 15(6):690-698.
26. 张雅娟, 闫军, 李守军, 等. 延长Fontan类手术患者住院时间的危险因素分析. 中国胸心血管外科临床杂志, 2014, 21(3):312-317.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early Results of Total Cavopulmonary Connection by Extracardiac Conduit in Adults with Complex Congenital Heart Disease

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