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Published in: Indian Journal of Thoracic and Cardiovascular Surgery 4/2018

01-10-2018 | Original Article

Immediate and early post-operative sequelae of off-pump total cavopulmonary connection

Authors: Sachin Talwar, Aabha Divya, Neeti Makhija, Shiv Kumar Choudhary, Balram Airan

Published in: Indian Journal of Thoracic and Cardiovascular Surgery | Issue 4/2018

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Abstract

Background

Extracardiac Fontan (ECF) is currently the final operation of choice for patients with a univentricular heart. Performing this procedure without cardiopulmonary bypass (CPB) carries potential benefits. In this study, we report the early results of ECF without CPB.

Patients and methods

Between 2012 and 2015, 72 consecutive patients underwent Fontan without CPB. Their medical records were examined in detail.

Results

Mean age was 11.8 ± 5.2 (range 5 to 23, median 10) years. Intraoperative mean superior vena cava clamp time was 15.19 ± 3.8 min, and the inferior vena cava clamp time was 16.93 ± 3.31 min. There were three early deaths. No patient required conversion from off-CPB to CPB. Mean inotropic score was 4.73 ± 5.9 (range 0 to 25, median 2.5). Mean time to extubation was 9.5 ± 5.82 (range 3 to 29, median 8) hours. Pleural drainage in intensive care unit (ICU) was 551.57 ± 452.77 (median 470) ml, and mean ICU stay was 2.27 ± 3.09 (median 1.5) days. Mean daily pleural drainage after discharge from the ICU was 163.7 ± 88.01 (median 140) ml, and mean time to removal of pleural tubes was 15.76 ± 8.4 (median 14) days. Total hospital stay was 17.03 ± 8.62 (median 15) days. At an early follow-up of 2–40 (median 25) months, all survivors (n = 69) had a patent Fontan circuit with normal ventricular function on echocardiography. There were no late deaths or thromboembolic complications.

Conclusions

Off-pump ECF is a low-risk procedure that avoids the harmful effects of CPB. Post-operative course of these patients is predictable with substantial savings in costs.
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Metadata
Title
Immediate and early post-operative sequelae of off-pump total cavopulmonary connection
Authors
Sachin Talwar
Aabha Divya
Neeti Makhija
Shiv Kumar Choudhary
Balram Airan
Publication date
01-10-2018
Publisher
Springer Singapore
Published in
Indian Journal of Thoracic and Cardiovascular Surgery / Issue 4/2018
Print ISSN: 0970-9134
Electronic ISSN: 0973-7723
DOI
https://doi.org/10.1007/s12055-017-0638-3

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