Document Detail

Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method.
MedLine Citation:
PMID:  15001901     Owner:  NLM     Status:  MEDLINE    
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.
Toshihide Nakano; Hideaki Kado; Shiro Ishikawa; Yuichi Shiokawa; Hiroya Ushinohama; Koichi Sagawa; Naoki Fusazaki; Yosuke Nishimura; Yoshihisa Tanoue; Tsuneyuki Nakamura; Yoshiharu Ueda
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-05     Completed Date:  2004-04-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  730-7     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 251 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan.
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MeSH Terms
Atrial Natriuretic Factor / blood
Exercise Test
Follow-Up Studies
Heart Atria / surgery
Heart Bypass, Right / adverse effects,  methods*
Heart Defects, Congenital / physiopathology,  surgery
Postoperative Complications
Tachycardia, Supraventricular / diagnosis,  etiology
Reg. No./Substance:
85637-73-6/Atrial Natriuretic Factor

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