Single stage versus two stage repair for univentricular heart—our experience

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• 作者：Sadashiv Tamagond (1)
  Saket Agarwal (1)
  Shashi Prakash (1)
  Sanjeev Singh (1) (2)
  Deepak Kumar Satsangi (1)
  
• 关键词：Glenn shunt ; Cardiopulmonary bypass ; Sternotomy
• 刊名：Indian Journal of Thoracic and Cardiovascular Surgery
• 出版年：2011
• 出版时间：June 2011
• 年：2011
• 卷：27
• 期：2
• 页码：83-87
• 全文大小：93KB
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• 作者单位：Sadashiv Tamagond (1)
  Saket Agarwal (1)
  Shashi Prakash (1)
  Sanjeev Singh (1) (2)
  Deepak Kumar Satsangi (1)
  
  1. Department of Cardio Vascular & Thoracic Surgery, G. B. Pant Hospital, New Delhi, India
  2. Department of Cardiothoracic & Vascular Surgery, G B Pant Hospital, New Delhi, 110002, India
  

文摘

Background Definitive palliation for complex cardiac anomalies with a functional single ventricle usually involves different modifications of Fontan operation/ Total Cavopulmonary Connection (TCPC). However, whether it should be done as one-stage procedure or two-stage procedure with initial bidirectional Glenn shunt remains an area of debate though many recent studies have shown benefit of two stage procedure particularly in high risk cases. Objective This retrospective study has been undertaken to compare the operative outcome and morbidity following one stage TCPC with that of two stage TCPC with preliminary BDG in our setup. Material and methods We retrospectively reviewed the clinical records of all the patients of single ventricle physiology who underwent cavopulmonary connections (TCPC) at our institution during the period of January 2001 to December 2009. 15 patients (9 male and 6 female) underwent single stage TCPC. 31 patients underwent initial Bidirectional Glenn (BDG) procedure of which 24 patients (14 male and 10 female) underwent completion TCPC 6?months to 26?months later (two-stage TCPC group). For all the patients in the two study groups various peri-operative parameters were analysed including cardiopulmonary bypass duration, ventilation time, Intensive Care Unit (ICU) stay, hospital stay, postoperative pleural drainage and other complications rate, in-hospital mortality and TCPC takedown. Results Overall mortality in two-stage TCPC is lower than one-stage TCPC (4.2% in two-stage TP vs 13.3% in one-stage TCPC). There is no mortality with initial BDG in two-stage TCPC. TCPC has to be taken down in 2 patients in one-stage TCPC. In two-stage TCPC completion TCPC could not be carried out in 5 patients due to high pulmonary artery pressure and small pulmonary arteries. Others postoperative outcomes are comparable in both groups. Conclusion Two-stage TCPC with intervening bidirectional Glenn shunt can offer a higher probability to proceed successfully to complete palliation in patients with single ventricle. Staging the TCPC also lowers the postoperative mortality in the present study.