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J Thorac Cardiovasc Surg 2004;127:730-737
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method

Toshihide Nakano, MDa, Hideaki Kado, MDa,*, Shiro Ishikawa, MDb, Yuichi Shiokawa, MDa, Hiroya Ushinohama, MDb, Koichi Sagawa, MDb, Naoki Fusazaki, MDc, Yosuke Nishimura, MDa, Yoshihisa Tanoue, MDa, Tsuneyuki Nakamura, MDb, Yoshiharu Ueda, MDb

a Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
b Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
c Department of Neonatal Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan Fukuoka Children's Hospital, Fukuoka, Japan.

Received for publication September 25, 2002; revisions received October 30, 2002; accepted for publication December 11, 2002.

* Address for reprints: Dr H Kado, Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 2-5-1 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan
f-kodomo{at}aurora.dti.ne.jp

OBJECTIVE: We evaluated the midterm surgical outcomes of intra-atrial lateral tunnel and extracardiac conduit total cavopulmonary connection to clarify the clinical superiority.

METHODS: Patients (n = 167) underwent total cavopulmonary connection (88 with lateral tunnel and 79 with extracardiac conduit) from November 1991 to March 1999. Survival, incidence of reoperation and late complications, exercise tolerance, hemodynamic variables, and plasma concentration of natriuretic peptide type A were compared. In the lateral tunnel group, time-related change in lateral tunnel size was investigated for its relationship to postoperative arrhythmias.

RESULTS: The 8-year survival was 93.2% in the lateral tunnel group and 94.9% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group but none in the extracardiac conduit group. Supraventricular arrhythmias developed in 14 patients (15.9%) in the lateral tunnel group and in 4 patients (5.1%) in the extracardiac conduit group (P = .003). Freedom from cardiac-related events was 72.5% in the lateral tunnel group and 89.8% in the extracardiac conduit group at 8 years (P = .0098). Hemodynamic variables and exercise tolerance were similar in both groups but plasma natriuretic peptide type A concentration, a parameter of atrial wall tension, was higher in the lateral tunnel group. In the lateral tunnel group, intra-atrial tunnel size increased by 19.4% during the 44.2-month interval and the percent increase in tunnel size was an independent predictor of supraventricular arrhythmias.

CONCLUSIONS: The midterm survival, hemodynamic variables, and exercise tolerance were similar and satisfactory in both lateral tunnel and extracardiac conduit groups; however, the incidence of cardiac-related events was significantly less frequent in the extracardiac conduit group. In the lateral tunnel group, careful observation is required to monitor the relationship of the dilating tendency of the intra-atrial tunnel and the development of late complications.




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