E. Snir et al., TOTAL CAVOPULMONARY CONNECTION (TCPC) FOR COMPLICATED CONGENITAL HEART MALFORMATIONS, Journal of Cardiovascular Surgery, 35(6), 1994, pp. 141-144
We reviewed our experience with 40 patients who had undergone total ca
vopulmonary connection (TCPC) during the past three years. Thirty-one
patients had functional single ventricle; only 8 of these with tricusp
id atresia, five patients had complex forms of double outlet right ven
tricle (DORV), and four complex A-V canal. Previous palliative procedu
res, mostly systemic-pulmonic shunts, were performed in 34 patients. C
oncomitant procedures were required in 18 patients, mainly reconstruct
ion of distorted pulmonary arteries. A subgroup of 14 high risk patien
ts, that did not fulfil the classical Fontan criteria, underwent 4 mm
fenestration of the intra-atrial baffle. There were three (7.5%) early
postoperative deaths which occurred in the higher risk group (fenestr
ated group). However, the remaining patients were all in functional cl
ass I or II. Total cavopulmonary connection provides reasonably good d
efinitive palliation for patients with single ventricle physiology. Fe
nestration of the intra-atrial baffle increases the number of candidat
es suitable for the Fontan procedure, although the exact inclusion cri
teria for these patients has yet to be defined.