Outcome of treatment of congenital univentricular heart using the method of total cavo-pulmonary connection
Abstract
Target: To determine the short-term and medium-term results of the total cavo-pulmonary connection (TCPC), and to analyze preoperative and postoperative anatomical, clinical and hemodynamic data to determine risk factors for failure of this operation (early death or need to cancel TCPC for unsustainable hemodynamics). Patient population: A group of 157 consecutive patients with univentricular heart, operated on at a middle age of 5.5 years, with a median follow-up of 3 years and 2 months.
Methodology: Clinical examination, ECG, echocardiography, catheterization and angiocardiography, interventional hemodynamic postoperative monitoring. Actuality analysis, multiple backward logistic regression.
Results: Early mortality 6.3%, TCPC failure 7.6%, late mortality 1.9%, actuarial probability of surviving six years after surgery 91 +- 2%. NYHA classification at last inspection: I - 55%, II - 38%, III - 7%, IV - 0%.
Rhythm at last check: sinus 80.3%, replacement atrial 8.8%, junctional 7.5%, AV block II. degrees 1.4% and complete AV block 2.0%. 8.3% of patients suffered a stroke after TCPC, 1.3% of patients suffered from exudative enteropathy. Risk factors for TCPC failure: subaortic obstruction and mean pressure in the TCPC system after surgery> 17 mm Hg.
Conclusion: TCPC opens a relatively safe path to a long-term satisfactory quality of life in patients with a univentricular heart. Risk factors for TCPC failure are subaortic obstruction and high blood pressure in the TCPC system after surgery.
We have not confirmed other risk factors that are the reason for the contraindication of this operation.