Early and Mid-Term Surgical Results of Total Cavopulmonary Connection

Objective- We evaluated the early and mid-term surgical outcomes and complications of intra-atrial lateral tunnel and extracardiac conduit total cavopulmonary connection to clarify the clinical superiority. Methods- Forty patients underwent total cavopulmonary connection (TCPC), 26 with lateral tunnel (LT) and 12 with extracardiac conduit (EC) repair, from July 1992 to June 2004 in two centers. Survival, incidence of reoperation and early complications were compared. Results- The hospital survival was 94.7% in the lateral tunnel group and 100% in the extracardiac conduit group. Seven reoperations were performed in the lateral tunnel group as opposed to three in the extra cardiac conduit group. Functional status of all survivors improved postoperatively. Significant enhancement of O2 saturation was seen after these operations (mean 72.3% preoperatively, reaching 91.7%). Surgical bleeding in the lateral tunnel repair group was 5.2% and 3.8%% for extracardiac conduit repair. Pericardial and pleural effusion was seen in 22% in the lateral tunnel and 17% in the extracardiac conduit group. In addition,whereas chylothorax occurred in 11% in the lateral tunnel, it was not seen in the extracardiac conduit group. Conclusions- The early survival and complications are 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. We recommend these procedures, especially EC-TCPC, as an alternative method for patients with complex heart abnormalities who are not candidates for total surgical repair (Iranian Heart Journal 2007; 8 (3): 16-20).