The right auricle tunnel as intercaval tunnel in total cavopulmonary connection may prevent atrial flutter

Objective: Total cavopulmonary connection (TCPC) is a routine operation for palliation of children with cardiac anomalies in whom biventricular repair is impossible. The original technique consists of the creation of a semi-p rosthetic intercaval tunnel. A substantial proportion of these patients dev elop atrial flutter. We developed a technique for creating an intercaval tu nnel that uses the tissue of the right auricle as intercaval tunnel. This t echnique avoids suture lines in the neighbourhood of the blood supply of th e sinus node and leaves the terminal crest free. Since atrial flutter frequ ently occurs after Mustard and Senning operations in which suture lines are similar as for creating the lateral tunnel in TCPC we postulated that our technique for coating the intercaval tunnel without prosthetic material mig ht prevent atrial flutter. Methods: All the children that qualified for a T CPC were included. Whenever possible our operative technique was applied. I n the other cases a semi-prosthetic conduit was used for creating the inter caval tunnel. Of 47 consecutive patients 30 (64%) had a tunnel of right aur icle tissue, 12 (26%) had a tunnel of prosthetic material. Five patients di d not need an intercaval tunnel and were omitted in this study. Only surviv ing patients were included in this study. Patients that needed more atrial surgery then necessary for TCPC were also omitted. Postoperative ECG's and Holter monitorings were studied. Results: Overall mortality was 7 of 47 pat ients (14.9% 70% CL 9.4-22.2%). There was no mortality due to rhythm distur bances. Atrial flutter occurred in 3 of 31 included patients (9.7, 70% CL 4 .3-18.5%). In the right auricle group 1 of 22 patients (4.5, 70% CL 0.6-14. 6%) had atrial flutter compared to 2 of 9 patients (22,2, 70% CL 7.5-45.0%) in the prosthesis group (P = 0.13). Conclusion: The use of the right auric ular technique for creating the intercaval tunnel TCPC is applicable in the majority of patients qualifying for a TCPC, Mortality and morbidity are eq ual comparing the two techniques. However, markedly less atrial flutter occ urs in the group where the right auricle was used as intercaval tunnel. The refore, we recommend the use of our technique for total cavopulmonary conne ction. (C) 1998 Elsevier Science B.V. All rights reserved.