TOTAL CAVOPULMONARY ANASTOMOSIS FOR DEFIN ITIVE PALLIATION IN COMPLEXUNIVENTRICULAR HEARTS - POTENTIAL PREOPERATIVE RISK-FACTORS

The modified Fontan operation for definitive palliation has been perfo rmed in an increasing number of patients with various forms of a funct ionally univentricular heart. To eliminate the influence of different surgical techniques only patients after total cavopulmonary anastomosi s (TCPA) were included in this retrospective analysis of preoperative risk factors. The age at operation in 72 patients varied from 7 to 219 months (median 54 months); 29 patients had been younger than 4 years. Forty-nine patients presented with a complex form of a functionally u niventricular heart; associated systemic- or pulmonary venous anomalie s were found in 22 patients, AV valve abnormalities in 42 patients wit h AV valve incompetence in 21 patients. Preoperative hemodynamic data revealed an elevated mean pulmonary artery pressure (> 15 mm Hg), incr eased pulmonary arteriolar resistance (> 3 U . m(2)) or end-diastolic ventricular pressure (> 12 mm Hg) in 23 patients. The overall mortalit y was 9.7 % (7/72 patients). Variables with significant influence on p ostoperative mortality were associated systemic- and pulmonary venous anomalies. AV-valve incompetence and prolonged cardiopulmonary bypass time. Age at operation, preoperative pulmonary arteriolar resistance, systemic- and pulmonary blood flow did not influence postoperative mor tality. Even in patients with a complex form of a univentricular heart with associated anomalies and borderline preoperative hemodynamics TC PA can be performed with an acceptable risk.