The Influence of Different Strategies on Clinical Outcome in Patients Undergoing Total Cavopulmonary Connection

Abstract

Background: We report on results of a prospective clinical trial designed to demonstrate the influence of various strategies in “Total Cavopulmonary Connection” (TCPC) for palliative therapy of patients with “single ventricle” physiology. Methods: From 1989 to 1997, a total of 47 patients (mean age 4.8 ±3.6 years) underwent definitive TCPC at our unit. 31 patients (66%) underwent one-stage TCPC, in 16 patients (34%) we performed a two-stage modified Fontan operation; 21 patients had central fenestration (4 mm). Inhalative NO therapy in the immediate postoperative period was adopted in 1993. Results: Overall 5-year survival was 76.4%, after two-stage TCPC 87.5%, and 81.3% in patients undergoing fenestrated procedures. Two of three patients survived perioperative Fontan take-down. We lost 11 patients (nine early and two late deaths): three patients died primarily because of neurologic dysfunction and eight patients because of cardiac failures. Under perioperative NO therapy there was no early death. After a mean follow-up of 35.9 ±23.3 months, 76% of all patients were in NYHA I and 21 % in NYHA l-ll. 89.7% had sinus rhythm. 42% of our patients suffered from temporary pleuropericardial effusions. Conclusions: Definitive palliation with TCPC achieves acceptable clinical results. Two-stage repair, fenestration, and postoperative inhalative NO therapy - each have a positive influence on early and long-term survival.

Key words

Fontan procedure - Pulmonary hypertension - Inhaled nitric oxide - Follow-up