Faculty Collaboration Database

Early cavopulmonary anastomosis after Norwood procedure results in excellent Fontan outcome. Ann Thorac Surg 2006 Oct;82(4):1260-5; discussion 1265-6

Date

09/26/2006

Pubmed ID

16996918

DOI

10.1016/j.athoracsur.2006.04.095

Scopus ID

2-s2.0-33748748733 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

BACKGROUND: Children with univentricular hearts and aortic arch obstruction are treated sequentially with Norwood procedure, superior cavopulmonary anastomosis (SCPA), and Fontan operation. Early SCPA results in lower initial O2 saturation and longer hospitalization, but not increased mortality. We sought to determine the impact of early SCPA on Fontan candidacy and outcomes.

METHODS: Eighty-five consecutive patients undergoing Norwood operation between January 1998 and February 2003 were divided into group 1 (SCPA at less than 4 months, n = 33) and group 2 (SCPA at more than 4 months, n = 52). Of the original cohort, 69 have undergone Fontan operation, 7 await Fontan, 1 was transplanted, 3 are not Fontan candidates, and 5 died late after SCPA. Group 1 (n = 25) and group 2 (n = 44) patients who have completed Fontan operation were compared for preoperative and perioperative variables: age, size, O2 saturation, pulmonary artery pressure and size, prevalence of tricuspid regurgitation and ventricular dysfunction, extubation rate in operating room, duration of pleural drainage, hospital stay, and discharge O2 saturation. Late functional status and ventricular function were also compared. Survival was compared for original groups 1 and 2.

RESULTS: There were no differences for any preoperative or perioperative variable, or late functional assessment. Actuarial survival at 6 years was also not different (88% +/- 5% for group 1 and 94% +/- 4% for group 2, p = 0.72).

CONCLUSIONS: Although initially more cyanotic and hospitalized longer than older peers, younger SCPA patients achieve clinical equivalence by the time of Fontan operation and afterward. We conclude that both short- and long-term outcomes support performance of early SCPA.

Author List

Jaquiss RD, Siehr SL, Ghanayem NS, Hoffman GM, Fedderly RT, Cava JR, Mussatto KA, Tweddell JS

Authors

Joseph R. Cava MD, PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Raymond T. Fedderly MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Stephanie S. Handler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen Mussatto Ph.D. Associate Professor in the School of Nursing department at Milwaukee School of Engineering

MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Cardiac Surgical Procedures
Child, Preschool
Fontan Procedure
Heart Defects, Congenital
Humans
Infant
Pulmonary Artery
Survival Analysis
Time Factors
Treatment Outcome
Vena Cava, Superior