The Effect of the Conduit Size on Middle-term Outcomes in Patients with Extracardiac Total Cavopulmonary Connection

Overview

Journal Interdiscip Cardiovasc Thorac Surg

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2024 Feb 19

PMID 38374222

Authors

Keiichi Hirose

Akio Ikai

Hiroki Ito

Motonari Ishidou

Daisuke Toritsuka

Yuji Nakamura

Seito Watanabe

Eiji Nakatani

Kisaburo Sakamoto

Affiliations

Soon will be listed here.

Abstract

Objectives: The 18- and 16-mm conduits in extracardiac total cavopulmonary connection (eTCPC) were reported to be optimal based on energy loss and flow stagnation at the relatively early phase. However, because the artificial conduit lacks growth potential, we have recently encountered some cases in which the conduit needs to be changed several years after eTCPC. These cases prompted us to reconsider the surgical strategy for eTCPC.

Methods: We reviewed our 20-year single-centre experience with eTCPC patients (n = 256) to compare the 18-mm conduit (n = 195) and 16-mm conduit (n = 61) in terms of mortality and morbidity.

Results: The 16-mm conduit was used significantly more frequently in patients whose main chamber was right ventricle (P < 0.001). There was also a significant difference in preoperative inferior vena cava pressure (P = 0.008). There was a significant difference in the actuarial rate of freedom from late-occurring complications, including mortality, between the 2 groups (P = 0.003). There was a significant difference in the actuarial rate of reoperation-free survival (P = 0.042); however, there was no significant difference in resurgical intervention for the conduit (P = 0.333). In multivariate analysis, preoperative inferior vena cava pressure was an independent predictor for late-occurring complications (hazard ratio 1.19; P = 0.026). Conduit size (18 or 16 mm) itself was not an independent predictive factor for late-occurring complications (P = 0.690).

Conclusions: The mid-term clinical outcomes in patients who underwent eTCPC were excellent with low mortality. Preoperative inferior vena cava pressure was the only predictive risk factor for postoperative morbidity, and the 16 mm conduit was not predictive thereof.

References

Marcelletti C, Corno A, Giannico S, Marino B . Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass. J Thorac Cardiovasc Surg. 1990; 100(2):228-32. View

Ovroutski S, Sohn C, Barikbin P, Miera O, Alexi-Meskishvili V, Hubler M . Analysis of the risk factors for early failure after extracardiac Fontan operation. Ann Thorac Surg. 2013; 95(4):1409-16. DOI: 10.1016/j.athoracsur.2012.12.042. View

Lee C, Lee C, Hwang S, Lim H, Kim S, Lee J . Midterm follow-up of the status of Gore-Tex graft after extracardiac conduit Fontan procedure. Eur J Cardiothorac Surg. 2007; 31(6):1008-12. DOI: 10.1016/j.ejcts.2007.03.013. View

Cao J, Marathe S, Zannino D, Celermajer D, Justo R, Alphonso N . Fontan operation at less than 3 years of age is not a risk factor for long-term failure. Eur J Cardiothorac Surg. 2021; 61(3):497-504. DOI: 10.1093/ejcts/ezab355. View

Itatani K, Miyaji K, Tomoyasu T, Nakahata Y, Ohara K, Takamoto S . Optimal conduit size of the extracardiac Fontan operation based on energy loss and flow stagnation. Ann Thorac Surg. 2009; 88(2):565-72. DOI: 10.1016/j.athoracsur.2009.04.109. View

Poterucha J, Johnson J, Taggart N, Cabalka A, Hagler D, Driscoll D . Embolization of Veno-venous Collaterals after the Fontan Operation Is Associated with Decreased Survival. Congenit Heart Dis. 2015; 10(5):E230-6. DOI: 10.1111/chd.12276. View

Alsaied T, Bokma J, Engel M, Kuijpers J, Hanke S, Zuhlke L . Predicting long-term mortality after Fontan procedures: A risk score based on 6707 patients from 28 studies. Congenit Heart Dis. 2017; 12(4):393-398. DOI: 10.1111/chd.12468. View

Downing T, Allen K, Goldberg D, Rogers L, Ravishankar C, Rychik J . Surgical and Catheter-Based Reinterventions Are Common in Long-Term Survivors of the Fontan Operation. Circ Cardiovasc Interv. 2017; 10(9). DOI: 10.1161/CIRCINTERVENTIONS.116.004924. View

Patel N, Friedman C, Herrington C, Wood J, Cheng A . Progression in Fontan conduit stenosis and hemodynamic impact during childhood and adolescence. J Thorac Cardiovasc Surg. 2020; 162(2):372-380.e2. DOI: 10.1016/j.jtcvs.2020.09.140. View

10.

Ikai A, Fujimoto Y, Hirose K, Ota N, Tosaka Y, Nakata T . Feasibility of the extracardiac conduit Fontan procedure in patients weighing less than 10 kilograms. J Thorac Cardiovasc Surg. 2008; 135(5):1145-52. DOI: 10.1016/j.jtcvs.2007.12.013. View

11.

Amodeo A, Galletti L, Marianeschi S, Picardo S, Giannico S, Di Renzi P . Extracardiac Fontan operation for complex cardiac anomalies: seven years' experience. J Thorac Cardiovasc Surg. 1998; 114(6):1020-30; discussion 1030-1. DOI: 10.1016/S0022-5223(97)70016-3. View

12.

FONTAN F, Baudet E . Surgical repair of tricuspid atresia. Thorax. 1971; 26(3):240-8. PMC: 1019078. DOI: 10.1136/thx.26.3.240. View

13.

Inai K, Inuzuka R, Ono H, Nii M, Ohtsuki S, Kurita Y . Predictors of long-term mortality among perioperative survivors of Fontan operation. Eur Heart J. 2021; 43(25):2373-2384. DOI: 10.1093/eurheartj/ehab826. View

14.

Ota N, Fujimoto Y, Murata M, Tosaka Y, Ide Y, Tachi M . Impact of postoperative hemodynamics in patients with functional single ventricle undergoing Fontan completion before weighing 10 kg. Ann Thorac Surg. 2012; 94(5):1570-7. DOI: 10.1016/j.athoracsur.2012.06.022. View

15.

Nakayama Y, Shinkawa T, Hoki R, Yoshida H, Katagiri J, Inai K . Surgical outcomes of reoperation after Fontan completion. Interact Cardiovasc Thorac Surg. 2021; 34(3):438-445. PMC: 8860415. DOI: 10.1093/icvts/ivab339. View

16.

de Leval M, Kilner P, Gewillig M, Bull C . Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg. 1988; 96(5):682-95. View