Objective To investigate the differences in postoperative mortality and identify potential influential factors in patients with a systemic left ventricle (SLV) versus a systemic right ventricle (SRV) following total cavopulmonary connection (TCPC). MethodsWe retrospectively collected data from functional single ventricle patients who underwent TCPC at the Department of Cardiac Surgery, Guangdong Provincial People’s Hospital, between October 2004 and July 2021. The cohort was categorized based on ventricular morphology into two groups: a SLV group and a SRV group. All procedures were performed via a median sternotomy under cardiopulmonary bypass. ResultsA total of 195 patients were included, comprising 108 patients in the SLV group (69 males, 39 females) and 87 in the SRV group (61 males, 26 females). The median age at surgery was 5.7 (IQR, 4.0-11.2) years, and the median body mass index (BMI) was 15.1 (IQR, 13.5-16.2) kg/m2 for the SLV group. For the SRV group, the median age was 5.7 (IQR, 4.1-8.9) years, and the median BMI was 14.7 (IQR, 13.6-15.9) kg/m2. The proportion of patients with situs inversus, heterotaxy syndrome, and moderate or greater atrioventricular valve regurgitation was significantly higher in the SRV group. Patients in the SRV group had a higher rate of fenestration and experienced longer aortic cross-clamp, cardiopulmonary bypass, and operative times, as well as prolonged postoperative hospital stays and chest tube durations. However, there were no statistical differences in early or late mortality between the two groups (P>0.05). Multivariate analysis identified pulmonary vascular resistance, postoperative aspartate aminotransferase, and postoperative creatinine as independent risk factors for mortality, while postoperative percutaneous oxygen saturation and hemoglobin levels were identified as protective factors. Conclusion The post-TCPC survival rate in patients with a SRV is non-inferior to that in patients with a SLV. However, the overall long-term mortality for both groups remains high, warranting close monitoring of the long-term survival outcomes in this patient population.
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.
ObjectiveTo investigate the management of hepatic vein (HV) in patients with functional single ventricle (FSV) and separate hepatic venous drainage (SHVD) undergoing total cavopulmonary connection (TCPC) and evaluate this kind of surgery.MethodsThe clinical data of 32 consecutive patients with SHVD who underwent modified TCPC operation from August 2005 to January 2017 in our center were retrospectively analyzed. There were 25 males and 7 females with an average age of 2-19 (8.0±5.0) years and body weight of 11-66 (25.4±15.8) kg.ResultsThere were 20 patients with heterotaxy syndrome and 12 patients with other types of FSV. SHVD was diagnosed preoperatively in 27 patients, among whom 20 patients were connected by intra-extracardiac Gore-Tex conduit, and the other 7 patients were connected by extracardiac Gore-Tex conduit. Because of the missed diagnosis of SHVD, the other 5 patients showed severe decrease of blood oxygen saturation in the early postoperative period and underwent re-operation soon. The postoperative blood oxygen saturation was 92.0% (90.0%, 96.0%), central venous pressure was 10-23 (15.5±3.5) mm Hg, mechanical ventilation assisted time was 16.0 (7.5, 24.0) h, and ICU stay time was 3.0 (2.0, 5.5) d. There were 3 early and 1 late deaths.ConclusionIntra-extracardiac conduit is an effective and feasible modified TCPC operation for patients with FSV and SHVD, while the surgical details need to be formulated in combination with individual anatomical structure. Preoperative missed diagnosis of SHVD must be avoided. Otherwise, after TCPC, a large amount of stealing blood from HV with low circulation pressure into atrium would lead to unacceptable hypoxemia.