| Midterm surgical results of total cavopulmonary connection: clinical advantages of the extracardiac conduit method. | |
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MedLine Citation:
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PMID: 15001901 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Toshihide Nakano; Hideaki Kado; Shiro Ishikawa; Yuichi Shiokawa; Hiroya Ushinohama; Koichi Sagawa; Naoki Fusazaki; Yosuke Nishimura; Yoshihisa Tanoue; Tsuneyuki Nakamura; Yoshiharu Ueda |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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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:
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Created Date: 2004-03-05 Completed Date: 2004-04-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 730-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Surgery, Fukuoka Children's Hospital, 251 Tojin-machi, Chuo-ku, Fukuoka 810-0063, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Natriuretic Factor
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blood Child Exercise Test Female Follow-Up Studies Heart Atria / surgery Heart Bypass, Right / adverse effects, methods* Heart Defects, Congenital / physiopathology, surgery Hemodynamics Humans Male Postoperative Complications Reoperation Tachycardia, Supraventricular / diagnosis, etiology |
| Chemical | |
Reg. No./Substance:
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85637-73-6/Atrial Natriuretic Factor |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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