Nonfenestrated Extracardiac Total Cavopulmonary Connection in 132 Consecutive Patients

Background: The study was conducted to assess the need for fenestration for completion of a total cavopulmonary connection (TCPC) with the most recent modification of an extracardiac conduit. Methods: The extracardiac approach was introduced to our institution in January 1999. Between June 2000 and June 2006, 132 consecutive patients were treated without a fenestration. At the time of TCPC, the median age was 31 months (range, 16 251), with 93 patients (70%) being younger than 48 months. Median patient weight was 12.5 kg (range, 9 to 66 kg). A previous partial cavopulmonary connection (PCPC) was accomplished in 117 patients (88.6%), without additional pulmonary blood flow. Results: Thirty-day-mortality was 1.5%. Median time to extubation was 14 hours (range, 3 hours to 126 days). Initial pulmonary artery pressure value was 16.5 ± 2.2 mm Hg, and 13.1 ± 1.8 after extubation. Median drainage requirement was 4 days (range, 1 to 45), and median duration of hospitalization was 20 days (range, 5 to 128). Thirty-one (24%) required repeat drainage insertion. No subsequent fenestration was performed, and at hospital discharge no significant repeat effusions were observed. Multiple covariate logistic regression revealed longer time interval from PCPC to extracardiac TCPC (p = 0.006) as a significant predictor of pleural drainage lasting longer than 4 days, and older age at the time of extracardiac TCPC (p = 0.040) as a risk factor for hospitalization more than 20 days. Higher pulmonary artery pressure 3 hours postoperatively was a significant predictor for both outcome variables in the multivariate model (p = 0.013, p = 0.001). Conclusions: In general, an extracardiac TCPC can be performed without fenestration. Early staging of patients with functional single ventricle physiology may be one of the keys for these findings.