PMID- 19161780
OWN - NLM
STAT- MEDLINE
DCOM- 20090211
LR  - 20090123
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 87
IP  - 2
DP  - 2009 Feb
TI  - Midterm to long-term outcome of total cavopulmonary connection in high-risk adult 
      candidates.
PG  - 562-70; discussion 570
LID - 10.1016/j.athoracsur.2008.10.040 [doi]
AB  - BACKGROUND: Adult patients who do not fulfill the classical Fontan criteria now 
      undergo total cavopulmonary connection (TCPC). However, limited information is 
      available on the results for high-risk adult TCPC. METHODS: Twenty-five 
      consecutive adult patients (aged 16 years or more) who underwent TCPC were 
      retrospectively reviewed. The mean age at operation was 27 +/- 9 years (range, 16 
      to 52). The following items were considered as the potential risk factors 
      according to previous reports: (1) aged more than 30 years (7 of 25); (2) 
      heterotaxy (9 of 25); (3) systemic ventricular ejection fraction less than 50% (6 
      of 25); (4) atrioventricular valve regurgitation moderate or greater (6 of 25); 
      (5) pulmonary arterial index less than 200 (7 of 25); (6) mean pulmonary arterial 
      pressure 15 mm Hg or greater (3 of 25); (7) pulmonary arterial resistance 2.0 
      wood units or greater (11 of 25); (8) arrhythmias (13 of 25); (9) protein-losing 
      enteropathy (3 of 25); (10) New York Heart Association (NYHA) functional class 
      III or greater (9 of 25); (11) previous Fontan procedure (10 of 25); (12) 
      systemic ventricular outflow obstruction (1 of 25); and (13) end-diastolic 
      pressure of the systemic ventricle 11 mm Hg or higher (4 of 25). RESULTS: The 
      mean follow-up period was 57 +/- 45 months (range, 0 to 154). All patients had at 
      least 2 risk factors (range, 2 to 8). There was 1 early death and 2 late deaths. 
      Comparing the late survivors and nonsurvivors, no statistical significance was 
      identified in the above risk factors. However, the patients with 6 or more risk 
      factors had a significantly higher mortality rate than patients with fewer than 6 
      risk risk factors (p < 0.01). Age (p = 0.08), NYHA class (p = 0.13), and 
      protein-losing enteropathy (p = 0.08) may be risk factors for late death. 
      CONCLUSIONS: The majority of the adult TCPC candidates tolerated the TCPC 
      procedure in the early postoperative period. However, the accumulation of risk 
      factors influences late mortality.
FAU - Fujii, Yasuhiro
AU  - Fujii Y
AD  - Department of Cardiovascular Surgery, Okayama University Graduate School of 
      Medicine, Dentistry, and Pharmaceutical Science, Okayama-City, Okayama, Japan.
FAU - Sano, Shunji
AU  - Sano S
FAU - Kotani, Yasuhiro
AU  - Kotani Y
FAU - Yoshizumi, Ko
AU  - Yoshizumi K
FAU - Kasahara, Shingo
AU  - Kasahara S
FAU - Ishino, Kozo
AU  - Ishino K
FAU - Akagi, Teiji
AU  - Akagi T
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Age Factors
MH  - Anastomosis, Surgical
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Fontan Procedure/*methods/*mortality
MH  - Heart Defects, Congenital/diagnosis/mortality/*surgery
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Oxygen Consumption/physiology
MH  - Postoperative Complications/mortality/physiopathology
MH  - Pulmonary Artery/*surgery
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Stroke Volume
MH  - Survival Rate
MH  - Time Factors
MH  - Venae Cavae/*surgery
MH  - Young Adult
EDAT- 2009/01/24 09:00
MHDA- 2009/02/12 09:00
CRDT- 2009/01/24 09:00
PHST- 2008/01/28 00:00 [received]
PHST- 2008/10/06 00:00 [revised]
PHST- 2008/10/08 00:00 [accepted]
PHST- 2009/01/24 09:00 [entrez]
PHST- 2009/01/24 09:00 [pubmed]
PHST- 2009/02/12 09:00 [medline]
AID - S0003-4975(08)02259-5 [pii]
AID - 10.1016/j.athoracsur.2008.10.040 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2009 Feb;87(2):562-70; discussion 570. doi: 
      10.1016/j.athoracsur.2008.10.040.