Risk factors influencing early and late mortality after total cavopulmonary connection

Objective: Among the later modifications of the, Fontan type procedure, a s ignificant alteration was introduced by de Leval and associates when they d escribed the total cavopulmonary connection (TCPC). Although current result s of TCPC have encouraged us to extend this procedure to high risk patients , risk factors influencing surgical outcome after TCPC have not been evalua ted. We review our experiences with TCPC to identify which risk factors may have had a considerable impact on the outcome of patients undergoing TCPC and to clarify selection criteria of high-risk Fontan candidates for TCPC. Patients and methods: We retrospectively reviewed the medical and surgical records of all 76 patients who underwent TCPC between July 1988 and August 2000. A cross-sectional review of these patients was undertaken. Results: T here were eight early deaths and four late deaths. In a Fisher's exact test , the following variables were associated with: an increased early mortalit y after TCPC: systemic ventricular morphology (right ventricle), ejection f raction of the systemic ventricle less than 60%, and prolonged cardiopulmon ary bypass time (240 min or longer). The log-rank test demonstrated that he terotaxy syndrome, moderate to severe atrioventricular valve regurgitation, prolonged cardiopulmonary bypass time (240 min or longer), and prolonged a ortic cross clamp time (70 min or loner) were associated with late mortalit y after TCPC. Six deaths occurred in eight (75%) patients who had six or mo re risk factors, whereas six deaths (9%) occurred in those who had five or fewer. Conclusions: Patients with complex cardiac anomalies who have six or more risk factors should be excluded from TCPC candidates. (C) 2001 Elsevi er Science B.V. All rights reserved.