Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2025-01-03T17:33:21.269Z Has data issue: false hasContentIssue false
  • English
  • Français

Open anastomosis of extracardiac conduit for total cavopulmonary connection decreases post-operative pleural effusion

Published online by Cambridge University Press:  02 September 2010

Ryo Aeba ,
Masanori Morita ,
Toru Matayoshi  and
Ryohei Yozu
Ryo Aeba*
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Keio University, Tokyo, Japan
Masanori Morita
Affiliation:
Department of Bioengineering, Keio University, Tokyo, Japan
Toru Matayoshi
Affiliation:
Department of Bioengineering, Keio University, Tokyo, Japan
Ryohei Yozu
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Keio University, Tokyo, Japan
*
Correspondence to: R. Aeba, MD, Department of Surgery, Division of Cardiovascular Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan. Tel: +81 3 3353 1211 Ext. 62331; Fax: +81 3 5379 3034; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The goal of this study was to see whether the open anastomosis technique using vacuum-assisted venous drainage at the time of the Fontan procedure was associated with decreased post-operative pleural effusion.

Methods

We analysed a subgroup of patients with a functional single ventricle who underwent non-fenestrated total cavopulmonary connection completion with the insertion of an extracardiac conduit as the sole or predominant procedure conducted by a single surgeon at a single institute, using either an open or closed anastomosis technique.

Results

Median age and weight were 2.3 years, with a range from 1.3 to 27.6 years and 11.4 kilograms, with a range from 9.7 to 43 kilograms, respectively. The open anastomosis technique was associated with a shorter bypass run (p = 0.015), decreased surgical duration (p = 0.032), fewer pleural effusion days (p = 0.049), and lesser pleural effusion (p = 0.013) than closed anastomosis. Correlation analysis demonstrated a significant relationship between the amount of pleural effusion and surgical duration (correlation efficient, 0.535; p = 0.033). A logistic regression model showed that the open technique was associated with a 20-fold increase in the likelihood of having a total chest tube discharge of less than 300 millilitres (p = 0.027).

Conclusions

The open anastomosis technique shortens operative duration and bypass run, which in turn might contribute to decreased pleural effusion soon after the modified Fontan procedure.

Keywords

Congenital cardiac diseaseFontancardiopulmonary bypassinflammatory response
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 6 , December 2010 , pp. 686 - 691
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gupta, A, Daggett, C, Behera, S, Ferraro, M, Wells, W, Starnes, V. Risk factors for persistent pleural effusions after the extracardiac Fontan procedure. J Thorac Cardiovasc Surg 2004; 127: 1664–1669.CrossRefGoogle ScholarPubMed
2. Gupta, M, Johann-Lian, R, Sison, CP, Quaegebeur, J, Friedman, DM. Relation of early pleural effusion after pediatric open heart surgery to cardiopulmonary bypass time and systemic inflammation as measured by serum interleukin-6. Am J Cardiol 2001; 87: 1220–1223.CrossRefGoogle ScholarPubMed
3. Kawahira, Y, Uemura, H, Yagihara, T. Impact of the off-pump Fontan procedure on complement activation and cytokine generation. Ann Thorac Surg 2006; 81: 685–689.Google Scholar
4. Mainwaring, RD, Lamberti, JJ, Hugli, TE. Complement activation and cytokine generation after modified Fontan procedure. Ann Thorac Surg 1998; 65: 1715–1720.Google Scholar
5. Aeba, R, Yozu, R, Morita, M, Matayoshi, T. Total cavopulmonary connection: open anastomosis of an extracardiac conduit with vacuum-assisted venous drainage. Ann Thorac Surg 2006; 81: 1146–1147.CrossRefGoogle ScholarPubMed
6. Jacobs, JP, Iyer, RS, Weston, JS, et al. Expanded PTFE membrane to prevent cardiac injury during resternotomy for congenital heart disease. Ann Thorac Surg 1996; 62: 1778–1782.Google Scholar
7. Lemler, MS, Scott, WA, Leonard, SR, Stromberg, D, Ramaciotti, C. Fenestration improves clinical outcome of the Fontan procedure: a prospective randomized study. Circulation 2002; 105: 207–212.CrossRefGoogle ScholarPubMed
8. Spicer, RL, Uzark, KC, Moore, JW, Mainwaring, RD, Lamberti, JJ. Aortopulmonary collateral vessels and prolonged pleural effusions after modified Fontan procedure. Am Heart J 1996; 131: 1164–1168.CrossRefGoogle Scholar
9. Fedderly, RT, Whitstone, BN, Frisbee, SJ, Tweddell, JS, Litwin, SB. Factors related to pleural effusions after Fontan procedure in the era of fenestration. Circulation 2001; 104 (Suppl I): I-148–I-151.CrossRefGoogle ScholarPubMed
10. Garofalo, CA, Cabreriza, SE, Quinn, TA, et al. Ventricular diastolic stiffness predicts perioperative morbidity and duration of pleural effusions after the Fontan operation. Circulation 2006; 114 (Suppl I): I-56–I-61.CrossRefGoogle ScholarPubMed
11. Yun, TJ, Im, YM, Jung, SH, et al. Pulmonary vascular compliance and pleural effusion duration after the Fontan procedure. Int J Cardiol 2009; 133: 55–61.CrossRefGoogle ScholarPubMed
12. Gaynor, JW, Bridges, ND, Cohen, MI, et al. Predictors of outcome after the Fontan operation: is hypoplastic left heart syndrome still a risk factor? J Thorac Cardiovasc Surg 2002; 123: 237–245.CrossRefGoogle ScholarPubMed
13. Lofland, GK. The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J Cardiothorac Surg 2001; 20: 114–119.CrossRefGoogle ScholarPubMed
14. Corno, AF, Horisberger, J, David, J, von Segesser, LK. Right atrial surgery with unsnared inferior vena cava. Eur J Cardiothorac Surg 2004; 26: 219–220.CrossRefGoogle ScholarPubMed