Extracardiac conduit versus lateral tunnel for total cavopulmonary connections.

OBJECTIVE: Compare the surgical outcomes of the lateral tunnel and the extracardiac conduit total cavopulmonary connections at a single center during a l0-year period. MATERIAL AND METHOD: From October 1995 through October 2005, 27 total cavopulmonary connections (TCPC) were performed. fourteen patients were the lateral tunnel and thirteen patients were the extracardiac conduit. Prior superior cavopulmonary connective surgery and fenestration surgery were done more often in the group with extracardiac conduit. RESULTS: Operative mortality was 29% in the lateral tunnel and no operative mortality in the extracardiac conduit (p < 0.05). The cause of deaths in three patients was significant AV valve regurgitations and one was small pulmonary artery index. All patients in both groups were in NYHA class 1 and 2 and no patients with supraventricular arrhythmias were detected in the two groups during the follow-up period There was only one patient in the lateral tunnel who developed thromboembolism from irregular warfarin taking. CONCLUSION: The extracardiac conduit had lower mortality than the lateral tunnel. However; there was no difference in early and mid-term complications.

Long-term outcome and factors influencing the outcome of thymectomy for myasthenia gravis.

Thymectomy has gained widespread acceptance as a treatment for patients with myasthenia gravis (MG). Patients with myasthenia gravis who had undergone thymectomy by extended transsternal approach between 1981 and 1987 were retrospectively reviewed to evaluate the result of thymectomy, time to remission, time to maximum improvement and factors influencing remission after thymectomy. There were 128 patients, 45 men and 83 women and the mean ages at the time of thymectomy were 35.7 and 32.2 years respectively. After thymectomy, 41.2% of the patients were in remission, 53% improved and 5.8% had no response. The remission rates at 1, 2, 5 and 10 years after thymectomy were 9%, 17%, 37% and 53% respectively and the median time to remission was 9 years. The maximum improvement rates at 1, 2, 5 and 10 years after thymectomy were estimated to be 30%, 40%, 57% and 78% respectively and the median time to maximum improvement was 3.6 years. Patients with ocular MG, longer duration of symptoms before thymectomy and atrophic thymus gland appeared to take longer to achieve remission although none of the factors was significantly associated with the time to remission. Thymectomy is beneficialfor MG patients with satisfactory remission and improvement rates. It is recommended that thymectomy should be advocatedfor these patients early in the course of the disease because the duration of the symptoms appeared to be the main determinant of the outcome.