ESTABLISHMENT OF TOTAL CAVOPULMONARY CONNECTION WITHOUT USE OF CARDIOPULMONARY BYPASS

Objective: To minimize deleterious postoperative influences of cardiop ulmonary bypass on the pulmonary circulation immediately after the Fon tan type procedure, total cavopulmonary connection was achieved withou t use of cardiopulmonary bypass. Methods: Since April 1996, 15 patient s including five patients with visceral heterotaxy, in whom no intraca rdiac procedure was needed, have undergone this operative maneuver. Ag e at operation ranged from 1.2 to 44.6 years. Construction of a system ic to pulmonary shunt had been previously employed in seven patients, banding of the pulmonary trunk in two patients, and the Norwood proced ure in one patient. The superior caval vein was initially anastomosed to the pulmonary arteries in bidirectional fashion under temporary byp ass from the superior caval vein to the atrium, The channel for draini ng the inferior caval vein was subsequently constructed with the aid o f temporary bypass from the inferior caval vein to the atrium, using a Goretex tube in ten patients, using a pedicled autologous pericardial roll in four patients, and directly anastomosing the pulmonary trunk to the orifice of the inferior caval vein in one patient. In patients with visceral heterotaxy and an independent hepatic venous drainage, r edirection of the: blood flow via the caval vein as well as the hepati c vein could be successfully achieved by placing dual temporary bypass es into these veins. Results: Postoperative courses were excellent in all patients. Superior caval venous pressure was 11 +/- 2 mmHg at 12 h after the operation. No blood transfusion was deeded in nine patients (60%). Conclusion: This alternative operative procedure is undoubtedly attractive when establishing the Fontan circulation in patients under going no intracardiac maneuvers. (C) 1998 Elsevier Science B.V. All ri ghts reserved.