The prognosis of the total cavopulmonary anastomosis in relation to the age at surgery

The purpose of this study was to evaluate the relations between the age of surgery and the postoperative results in children after a total cavopulmona ry anastomosis (TCPA). Between February 1990 and August 1995 53 patients un derwent a TCPA in our institution. At the time of the operation 26 of the p atients were younger than 4 years, 27 patients were more than 4 years old. The perioperative mortality for all patients was 9.4%. Among the young chil dren the perioperative mortality was higher than in the older patients (15. 4% vs 3.7%). The only 2 patients who died late after surgery (2.8 and 2.6 y ears postoperatively) had been 8.3 and 9.0 years old at the time of their T CPA and represent 7.7% of the initially surviving patients of that group. The follow-up was based on routine heart catheterizations in 25 of our pati ents carried out 3.6 +/- 0.7 (m +/- SD) years postoperatively. Sixteen pati ents underwent a bicycle exercise test 4.0 +/- 1.0 years postoperatively an d in 32 patients a Holter-ECG was obtained 3.2 +/- 1.2 years postoperativel y (Table 1). The systemic cardiac index (CI), obtained at the catheterizati on laboratory, was only slightly reduced with 3.0 +/- 1.0 l/min/m(2) (norma l 3.5-5.5 l/min/m(2)). We saw a weak but significant negative correlation b etween the CI and the age at the TCPA (r = -0.43; p = 0.03; Figure 1). The maximal work load at the exercise test also showed a weak negative correlat ion to the age of surgery (r = -0.50; p = 0.05; Figure 2). Only 43.75 % of our patients had no arrhythmias at the Holter-ECG. Again the group of child ren with no arrhythmias had been operated on at a significant lower age tha n the group of patients with anhythmias (3.9 vs 7.3 years; p = 0.02; Figure 3). At follow-up the patients were all in good condition. Patients who had the TCPA in a relatively young age showed a better cardiac output, a highe r work load at exercise testing and less arrhythmias than patients who were operated on when they were older. Therefore in suitable patients we recommend to carry out the TCPA at the 3r d or 4th year of life. The higher intraoperative mortality in young childre n should be overcome by excluding patients with additional preoperative ris k factors.