Single or 2-stage total cavo-pulmonary connection to correct the complex congenital heart diseases? - Single center experience and lessons from 88 cases

Abstract

Objective To summarize the experience of single or 2-stage total cavo-pulmonary connection (TCPC) to correct the complex congenital heart diseases in children. Methods From December 2003 to November 2009, 88 patients underwent TCPC at this center. Among them, 58 were male and 30 were female. Surgical risks were assessed before surgery. The 41 patients with low surgical risks underwent single stage TCPC, and the other 47 high risk patients were performed 2-stage TCPC. Among the single stage TCPC group,extracardiac conduits were performed on 27 patients,and direct anastomosis between pulmonary trunk and inferior vena cava on the other 14 patients. Among the patients performed 2-stage TCPC, extracardiac conduits were performed on 42 patients, intracardiac conduit on 3, and direct anastomosis between pulmonary trunk and inferior vena cava on the rest 2 patients. Results Six patients died after surgery with overall mortality of 6. 8%,including 5 with single stage TCPC patients (mortality, 12. 2%) and 1 with 2-stage TCPC patient (mortality,2. 1 %). Among the five deaths with single stage TCPC,4 died for severe low cardiac output syndrome,and the other 4 died for respiratory failure. The 1 death with 2-stage TCPC died for severe bleeding when opening the chest during the operation. No significant differences of mechanical ventilating time, duration of chest tube, ICU duration, and post-operative hospital stay were noted between the 2 groups. The 65 survived patients were followed up from 4. 0 months to 6. 5 years. On patient died for sever atrialventricular valve regurgitation and heart failure 8 months later after the surgery. One patient died for multiple organs failure caused by infective endocarditis. Conclusions This study suggests the short-term outcomes of 2-stage TCPC are better than the single stage TCPC. The 2-stage TCPC is recommended to all the patients especially to the patients with 2 or more risk factors. Key words: Heart defects,congenital; Total cavopulmonary connection; Cardiac surgical procedures