Собственный опыт рутинного использования разгрузочной фенестрации при операциях тотального кавопульмонального соединения, определение критериев и сроков ее закрытия

Abstract

Introduction. Extracardiac conduit fenestration, the connection between systemic and pulmonary venous returns, is created to reduce the risk of postoperative complications in patients after total cavopulmonary connection (TCPC) procedure. Materials and Methods. From July 2009 to December 2015, 63 consecutive patients underwent extracardiac conduit TCPC with a fenestration of 4 mm. Six months after TCPC procedure, all patients underwent routine cardiac catheterization to solve the question of fenestration closure. Results. Before fenestration closure, systemic oxygen saturation was 84.9% (median: 85; range: 83–88), mean extracardiac TCPC circuit pressure was 9.27 mm Hg (median: 10; range: 7–11), transpulmonary pressure gradient (TPG) was 4.92 mm Hg (median: 5; range: 4–6). After fenestration closure in all patients, there was an increase of mean extracardiac TCPC circuit pressure less than 3 mm Hg from baseline 11.65 mm Hg (median: 13; range: 9–15). Systemic oxygen saturation was 94.6% (median: 95; range: 94–96), р<0.001. Conclusions. The optimal time for fenestration closure is six months after TCPC. Contraindications to fenestration closure are: baseline mean extracardiac TCPC circuit pressure more than 15 mm Hg, the increase of mean extracardiac TCPC circuit pressure after balloon occlusion more than 5 mm Hg from baseline, and the increase of TPG more than 10 mmHg.