Clinical advantages of total cavopulmonary anastomosis without cardiopulmonary bypass / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (EC-TCPA) without cardiopulmonary bypass (CPB).</p><p><b>METHODS</b>From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (no-CPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period.</p><p><b>RESULTS</b>There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appeared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short Intensive cares unit stay (P = 0.04) and hospital stay (P = 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P = 0.004) in no-CPB group compared with CPB group.</p><p><b>CONCLUSIONS</b>EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.</p>

Surgical treatment for double outlet of the right ventricle / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience and results of surgical treatment for double outlet of the right ventricle (DORV).</p><p><b>METHODS</b>From May 1985 to December 2001, 41 patients with DORV with age ranging from 10 months to 21 (mean age 10 +/- 6) years underwent surgical treatment. There were 26 male and 15 female patients. 14 patients underwent the classical Rastelli procedure (an intraventricular tunnel and a extra cardiac conduit repair); intraventricular tunnel and relive right ventricle outflow tract directly with and with out pericardial patch in 11; and modified Rastelli procedure in 11; total cavopulmonary connection (TCPC) in 2; Bidirection cavopulmnary connection in 2; Arterial switch operation in 1. All patients underwent the procedure by cardiopulmonary bypass.</p><p><b>RESULTS</b>There were 1 early death, 40 patients were discharged without any complication. Thirty-six patients were followed up from 5 months to 17 years. Reoperation in 3, because of residual ventricular septal defect in 1 and left ventricle outflow tract stenosis in 2. All patients were asymptomatic and did well in ordinary life. The cardiac function were in NYHA class I in 34 and class II in 2. The outcome was satisfactory.</p><p><b>CONCLUSIONS</b>Biventricular repair can be achieved in most patients with DORV with satisfactory early and late results, and the late survival was exciting. In complex DORV, a right heart bypass procedure is related to a lower surgical mortality.</p>