Modified intra/extracardiac conduit total cavopulmonary connection for the treatment of complex congenital heart disease / 中国胸心血管外科临床杂志

@#Objective     To investigate the surgery experience of modified intra/extracardiac conduit total cavopulmonary connection (TCPC). Methods     We retrospectively analyzed clinical data of 47 patients of complex congenital heart disease undergoing intra/extracardiac conduit total cavopulmonary connection in our hospital between January 2008 and December 2015. There were 29 males and 18 females with a median age of 7 years (range 4 to 9 years) and median body weight of 22 kg (range 14 to 38 kg). The heart echocardiography and cardiac imaging confirmed diagnosis suitable for TCPC surgery. Results     There was no early death in the whole group. The mean pulmonary arterial pressure was 16 (12–20) mm Hg and the ventilation time was 14 (7–97) h. The main complications were intractable pleural effusion in 7 patients, low cardiac output syndrome in 3 patients, repeated supraventricular tachycardia in 1 patient. All the patients recovered after treatment. At the end of discharge, the percutaneous oxygen saturation was 85%–96% (92.6%±3.3%). The echocardiography showed the conduit pressure was 0–2 mm Hg. Patients were followed up for 1 to 7 years. Three patients were lost. One patient had intestinal nutrition loss, receving repeated pleural effusion, the treatment was ineffective, died after 4 years. Four patients of repeated pleural effusion improved after treatment. One patient repeated attacks supraventricular tachycardia within 1 year, controlled by amiodaronum, already stopped about 28 months. No recurrence occurred. All survivors were in New York Heart Association (NYHA) functional class Ⅰ or Ⅱ, with good activity tolerance. Conclusion     The modified intra/extracardiac conduit TCPC combines the advantages of both the lateral tunnel and the extracardiac conduit. The operation is simple, used in the treatment of complex congenital heart disease. The short-term and mid-term results are encouraging.

Clinical experience of the treatment in congenital heart disease single ventricle with extracardiac conduit fenestration-95 cases / 中国综合临床

Objective To sum the clinical experiences of the treatment in congenital heart disease single ventricle with extracardiac conduit (EC) fenestration.Methods Ninety-five patients diagnosed with univentricular heart disease underwent EC using Gore-Tax conduits at the Department of Children's Heart Center,Justus-Liebig-University Giessen Germany from June 1996 to July 2010.According to EC with or without fenestration,the patients were divided into two groups.Seventy-one routine fenestration of the extracardiac conduit (the fenestration group),58 patients (58/71) of children with high-risk preoperative intraoperative fenestration,13 cases (13/71) were due to low cardiac Rankinginterventional fenestration; extracardiac conduit fenestration (non-windowed group) did not undergo surgery in 24 patients (24/95).Results The fenestration had no death; Three died in non-windowed group.Postoperative effusions and postoperative mean pulmonary artery pressure in group without fenestration ((14.2 ± 2.3) d and (15.1 ± 3.4) mm Hg respectively) were significantly higher than group with fenestration ((10 ± 3.2) d and (13.2 ± 2.8) mm Hg respectively).It had significant differences(P =0.016).In the group with fenestration and without fenestration,postoperative oxygen saturation((90.3 ±4.0)％,(91.7 ±5.2)％),postoperative thrombosis (11.3％ (8/71),12.5％ (3/24)),and postoperative neurological problems (18.3％ (13/71),20.8％ (5/24)) did not differ between cohorts.Conclusion It is effective and safe to treat congenital heart disease single ventricle with EC.EC with fenestration can improve acute postoperative mortality by rising cardiac output,thereby can reduce early postoperative mortality.

Outcome after Fontan Operation in Korea

PURPOSE: Despite extracardiac conduit Fontan had many advantages, long-term results related to longevity of conduit, and anticoagulation were not proven. This study was to evaluate the long-term outcome of hospital survivors with extracardiac Fontan circulation. METHODS: Between 1996 and 2006, 200 patients underwent extracardiac conduit Fontan operation. Median age at the Fontan operation was 3.4 years (range:16 months-35.7 years). All patients (89.5 %) except 21 patients of one stage Fontan operation underwent bi-directional cavopulmonary shunt. Fenestration was required in 85 patients (42.5%). RESULTS: There has been 6 hospital mortalities (3.0%), and 7 late mortalities (3.6%) at a mean follow-up of 52.4+/-32.2 months (range; 18days-120 months). Overall 10-years survival was 92.4 2.1%. Multivariate analysis identified severe infection at early postoperative periods (hazard ratio =12.439, P=0.001), and high pulmonary arterial pressure at preoperative period (hazard ratio=3.445, P=0.038) as risk factors for mortality. Reoperation was performed in 24 patients (12.0%), and freedom from reoperation was 82.4+/-4.1% at 10 years. Arrhythmia occurred in 32 patients (16.0%) after Fontan operation, and freedom from arrhythmia was 85.14.4% at 10 years. Risk factors for arrhythmia were heterotaxy syndrome (P=0.001), Follow up duration (P=0.027) and the age at Fontan operation (P=0.001). Freedom from thromboembolism was 92.91.9% at 10 years. The conduit cross- sectional area decreased by 14%, and the extent of decrease of the conduit cross-sectional remained stable irrespective of the follow-up duration. 95.2% of patients had New York Heart Association class I. CONCLUSIONS: After 10 years of follow-up, the overall survival, and the functional status of survivors of the extracardiac Fontan procedure are satisfactory. Fenestration has a beneficial effect on the results of high-risk Fontan patients. The incidence of late deaths, reoperations, obstructions of the cavopulmonary pathway, arrhythmias and thromboembolisms is low.

Mid- and Long Term Outcome of Fontan Procedure: Extracardiac Conduit Fontan versus Lateral Tunnel Fontan / 대한흉부외과학회지

BACKGROUND: This paper reviews our experience retrospectively to examine the clinical results and effectiveness of lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution. MATERIAL AND METHOD: One hundred and sixty five Fontan procedures were performed (67 LT and 98 ECC) between January 1996 and December 2006. Preoperative and postoperative hemodynamic values, arrhythmia, hospital and intensive care unit stay, chest tube drain, morbidity and mortality were reviewed. RESULT: The overall operative mortality in the LT and ECC groups was 4.5% (3) and 2.0% (2), respectively. There was a significant difference in the immediate postoperative transpulmonary gradient (LT 8.5+/-2.5 vs ECC 6.6+/-2.4, p-value<0.001) and central venous pressure (LT 18.3+/-3.8 vs ECC 15.6+/-2.4, p-value=0.001) between the two groups. The mean follow-up in the LT and ECC groups was 74.1+/-31.5 and 38.1+/-29.1 months, respectively. There was one late death. The actuarial survival at 10 years in the LT and ECC groups was 92% and 89%, respectively. In arrhythmia, the ECC patients showed a slightly low incidence but the difference was not statistically significant. CONCLUSION: Both the LT and ECC Fontan procedures showed comparable early and mid-term outcomes in terms of the surgical morbidity and mortality, postoperative hemodynamics, and mid-term survival. The ECC Fontan procedure reduces the risk of arrhythmia in the follow up period.

Early and Midterm Results of the Extracardiac Fontan Operation and the Change of Internal Diameter of the Conduit / 대한흉부외과학회지

BACKGROUND: Follow-up studies have shown that although outcomes have improved substantially over time,results of the Fontan operation and its modifications remain suboptimal.In this study,we reviewed our experience with the extracardiac conduit Fontan operation,with a focus early and midterm change of internal diameter of PTFE conduit. MATERIAL AND METHOD: Between April 1997 and July 2000 were reviewed.Twelve patients (M:6,F:6,mean age 42.04 +/- 12.43months,mean body weight 13.80 +/- 1.94kg)underwent extracardiac conduit Fontan operation with expanded PTFE graft.Mean cardiopulmonary bypass time was 109.7 +/- 26.99minute and mean operation time was 455 +/- 89.51minute. Intraoperative fenestration was performed in 10 patients.The aortic cross clamping was not performed in all patients. RESULT: There was no early deaths and no postoperative dysrhythmia. Postoperative protein losing enteropathy and prolonged pleural effusion occurred in 1(8.3%)and 4 patients(33.3%).Conduit patency was evaluated by magnetic resonance imaging studies.A 9.84 +/- 3.84%mean reduction in conduit internal diameter and there was no statistical correlation between the change of internal diameter of conduit and the postoperative duration after partial correlation analysis(r=0.019,p=0.955). CONCLUSION: These results demonstrate that the extracardiac conduit Fontan operation provies good early and midterm results and may reduce the prevalence of late arrhythmia.And there is no correlation between the change of internal diameter of conduit and the postoperative duration after extracardiac conduit Fontan operation with the expanded PTFE graft conduit.

Modified Extracardiac Fontan Procedure in a Univentricular Heart with Separate Hepatic and Inferior Vena Caval Drainage / 대한흉부외과학회지

In a patient with single ventricle associated with complex systemic and/or pulmonary venous drainage, intraatrial Fontan procedure is sometimes technically difficult due to the complex spatial relationship between their orifices in the atrium. We report a case of the modified extracardiac conduit Fontan procedure in a patient with a single ventricle in which the inferior vena cava and the hepatic vein drained separately into the atrium and the intraatrial orifice of the hepatic vein was abut to the orifice of the left lower pulmonary vein.