BIDIRECTIONAL GLENN FOLLOWED BY TOTAL CAVOPULMONARY CONNECTION OR PRIMARY TOTAL CAVOPULMONARY CONNECTION

Objective: Analysis of mortality and morbidity of patients treated by primary total cavopulmonary connection (TCPC)-Primary correction group , and comparison to patients treated by bidirectional Glenn (BDG) foll owed by total cavopulmonary connection-two stage TCPC group. Methods: Retrospective study of 123 consecutive patients who underwent 144 diff erent types of cavopulmonary connections between 1987-1995: bidirectio nal Glenn 59, HemiFontan operation 10, primary total cavopulmonary con nection 54, and total cavopulmonary connection completion after previo us bidirectional Glenn 21. Important preoperative risk factors. age: s ystemic outflow obstruction, pulmonary venous obstruction, pulmonary a rtery (PA) hypoplasia (McGoon ratio), PA stenosis/distortion, PA mean pressure, PA vascular resistance, atrioventricular valve regurgitation , systolic and diastolic ventricular function and ventricular hypertro phy were re-evaluated according to Texas Heart Institution Scoring Sys tem in both groups. Three different preoperative risk groups were esta blished: low risk, score (0-3) moderate risk (4,5) and high risk score (greater than or equal to 6). Results: Mean age was 85.2 month (range 16.1-229.5 months) and 106.6 months (range 42.6-178.9 months) in prim ary correction group and two Stage TCPC group, respectively. Diagnosis was similar in both groups, majority having univentricular heart or h ypoplastic one ventricle. Initial palliation (pulmonary artery banding , modified aortopulmonary shunt, coarctation repair etc.) was performe d in 38 (70.3%) patients of primary correction group and in 12 (57.1%) two stage TCPC group. The mortality was 7.4% (4 out of 54) and 14.2% (3 out of 21) for primary correction and two stage TCPC group, respect ively. There were two take down in the primary correction group. There was no late death in either group. Operative data and postoperative m orbidity did not statistically differ in both groups. Conclusion: Unti l 1993 bidirectional Glenn was preferred to primary total cavopulmonar y connection for high risk patients. High mortality 14.2% patients of two stage TCPC group vs. 7.4% of primary correction group in patients with the same preoperative hazard led us to change our policy. We now prefer primary TCPC for all patients with functional single ventricle and surgically correctable major associated defects. High risk patient s undergo TCPC with fenestration. Patients not suitable for TCPC under go either HemiFontan operation or some type of initial palliative proc edure. (C) 1997 Elsevier Science B.V.