Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes
Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period. Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2001-12, Vol.122 (6), p.1219-1228 |
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| creator | Azakie, Anthony McCrindle, Brian W. Van Arsdell, Glen Benson, Lee N. Coles, John Hamilton, Robert Freedom, Robert M. Williams, William G. |
| description | Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period. Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex, and weight did not differ between the 2 groups. Compared with the lateral tunnel group (LT group), patients undergoing the extracardiac conduit procedure (EC group) had a trend to a higher incidence of morphologically right ventricle (EC group 48% vs LT group 32%; P |
| doi_str_mv | 10.1067/mtc.2001.116947 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_72310810</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022522301604276</els_id><sourcerecordid>72310810</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-10790a16a42438c4565e70925ef253fe19d113ee4f9f528502ee1dfaa68e5b823</originalsourceid><addsrcrecordid>eNp1kD1vFTEQRS1ERB6Bmg65AdHsi8f7abooChApUpog0VkT72ziyGsvtvdB_j272ieloppizr2aOYx9ALEH0bTnYzZ7KQTsARpVta_YDoRqi6arf71mOyGkLGopy1P2NqUnIUQrQL1hpwCtbDqldmy6-psjGoy9RcNN8P1sMz9QTHPiDjNFdDzP3pPjBg9hmt0YPMbnlfVksg0-ccwcebL-wRG3PmWb53XxlV-PE5rMg-dhziaMlN6xkwFdovfHecZ-fru6u_xR3Nx-v768uClMVbW5ANEqgdBgJauyM1Xd1NQKJWsaZF0OBKoHKImqQQ217GohiaAfEJuO6vtOlmfs89Y7xfB7ppT1aJMh59BTmJNuZQmiA7GA5xtoYkgp0qCnaMflQw1Cr5L1IlmvkvUmeUl8PFbP9yP1L_zR6gJ8OgKYDLohojc2vXBl2ZUS1hu_bNyjfXj8YyPpNKJzSy3op2wSSKkbDRLWSrWhtDg7WIo6GUveUL_ETNZ9sP-99x8pwqfs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>72310810</pqid></control><display><type>article</type><title>Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Azakie, Anthony ; McCrindle, Brian W. ; Van Arsdell, Glen ; Benson, Lee N. ; Coles, John ; Hamilton, Robert ; Freedom, Robert M. ; Williams, William G.</creator><creatorcontrib>Azakie, Anthony ; McCrindle, Brian W. ; Van Arsdell, Glen ; Benson, Lee N. ; Coles, John ; Hamilton, Robert ; Freedom, Robert M. ; Williams, William G.</creatorcontrib><description><![CDATA[Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period. Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex, and weight did not differ between the 2 groups. Compared with the lateral tunnel group (LT group), patients undergoing the extracardiac conduit procedure (EC group) had a trend to a higher incidence of morphologically right ventricle (EC group 48% vs LT group 32%; P <.09), a higher incidence of isomerism/heterotaxy syndrome (EC 22% vs LT 0%; P <.001), worse atrioventricular valve regurgitation (EC 11% moderate-plus vs LT 0%; P <.06), and lower McGoon indices (EC 1.8 ± 0.5 vs LT 2.1 ± 0.5; P <.03). Preoperative arrhythmias, transpulmonary gradients, room air oxygen saturations, ejection fractions, ventricular end-diastolic pressure, and pulmonary artery distortion did not differ between groups. Cardiopulmonary bypass times and fenestration usage were similar in both groups. Results: Overall operative mortality was 5.6% and did not differ between groups. The LT group had a significantly higher incidence of postoperative sinoatrial node dysfunction (45% vs EC group 15%; P <.007), supraventricular tachycardia (33% vs EC group 8%; P <.0009), and need for temporary postoperative pacing (32% vs 12%; P <.01). Median duration of intensive care unit stay (EC 2 days, range 1-10 days, vs LT 2.8 days, range 1-103 days; P <.07) and ventilatory support (EC 1 day, range 0.25-10 days, vs LT 1 day, range 0.25-99 days; P <.03) were all longer in the LT group. Median chest tube drainage (EC 8 days, LT 9 days) was similar in both groups. Follow-up averaged 2.5 ± 1.4 years in the EC group and 2.8 ± 1.9 years in the LT group. There were 2 late deaths. Overall survival is 94% at 1 month, 92% at 1 year, and 92% at 5 years. Late ejection fraction or atrioventricular valve function did not differ between groups. Intermediate follow-up Holter analysis showed a higher incidence of atrial arrhythmias in the LT group (23% vs 7%; P <.02). Multivariable analysis showed that (1) prolonged cardiopulmonary bypass time was the only independent predictor for perioperative mortality, prolonged ventilation and intensive care unit length of stay, and increased time to final removal of chest tube drains and (2) lateral tunnel Fontan connection is an independent predictor of early postoperative and intermediate atrial arrhythmias. Conclusions: Although patients in the EC group were at higher preoperative risk, their outcomes were comparable with those of the LT group. Use of the extracardiac conduit technique for the modified Fontan operation reduces the risk of early and midterm atrial arrhythmia.]]></description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1067/mtc.2001.116947</identifier><identifier>PMID: 11726899</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Arrhythmias, Cardiac - epidemiology ; Biological and medical sciences ; Child, Preschool ; Female ; Fontan Procedure - methods ; Fontan Procedure - mortality ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Hospital Mortality ; Humans ; Male ; Medical sciences ; Morbidity ; Postoperative Complications - epidemiology ; Pulmonary Artery - surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2001-12, Vol.122 (6), p.1219-1228</ispartof><rights>2001 American Association for Thoracic Surgery</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-10790a16a42438c4565e70925ef253fe19d113ee4f9f528502ee1dfaa68e5b823</citedby><cites>FETCH-LOGICAL-c447t-10790a16a42438c4565e70925ef253fe19d113ee4f9f528502ee1dfaa68e5b823</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1067/mtc.2001.116947$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13383212$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11726899$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azakie, Anthony</creatorcontrib><creatorcontrib>McCrindle, Brian W.</creatorcontrib><creatorcontrib>Van Arsdell, Glen</creatorcontrib><creatorcontrib>Benson, Lee N.</creatorcontrib><creatorcontrib>Coles, John</creatorcontrib><creatorcontrib>Hamilton, Robert</creatorcontrib><creatorcontrib>Freedom, Robert M.</creatorcontrib><creatorcontrib>Williams, William G.</creatorcontrib><title>Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description><![CDATA[Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period. Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex, and weight did not differ between the 2 groups. Compared with the lateral tunnel group (LT group), patients undergoing the extracardiac conduit procedure (EC group) had a trend to a higher incidence of morphologically right ventricle (EC group 48% vs LT group 32%; P <.09), a higher incidence of isomerism/heterotaxy syndrome (EC 22% vs LT 0%; P <.001), worse atrioventricular valve regurgitation (EC 11% moderate-plus vs LT 0%; P <.06), and lower McGoon indices (EC 1.8 ± 0.5 vs LT 2.1 ± 0.5; P <.03). Preoperative arrhythmias, transpulmonary gradients, room air oxygen saturations, ejection fractions, ventricular end-diastolic pressure, and pulmonary artery distortion did not differ between groups. Cardiopulmonary bypass times and fenestration usage were similar in both groups. Results: Overall operative mortality was 5.6% and did not differ between groups. The LT group had a significantly higher incidence of postoperative sinoatrial node dysfunction (45% vs EC group 15%; P <.007), supraventricular tachycardia (33% vs EC group 8%; P <.0009), and need for temporary postoperative pacing (32% vs 12%; P <.01). Median duration of intensive care unit stay (EC 2 days, range 1-10 days, vs LT 2.8 days, range 1-103 days; P <.07) and ventilatory support (EC 1 day, range 0.25-10 days, vs LT 1 day, range 0.25-99 days; P <.03) were all longer in the LT group. Median chest tube drainage (EC 8 days, LT 9 days) was similar in both groups. Follow-up averaged 2.5 ± 1.4 years in the EC group and 2.8 ± 1.9 years in the LT group. There were 2 late deaths. Overall survival is 94% at 1 month, 92% at 1 year, and 92% at 5 years. Late ejection fraction or atrioventricular valve function did not differ between groups. Intermediate follow-up Holter analysis showed a higher incidence of atrial arrhythmias in the LT group (23% vs 7%; P <.02). Multivariable analysis showed that (1) prolonged cardiopulmonary bypass time was the only independent predictor for perioperative mortality, prolonged ventilation and intensive care unit length of stay, and increased time to final removal of chest tube drains and (2) lateral tunnel Fontan connection is an independent predictor of early postoperative and intermediate atrial arrhythmias. Conclusions: Although patients in the EC group were at higher preoperative risk, their outcomes were comparable with those of the LT group. Use of the extracardiac conduit technique for the modified Fontan operation reduces the risk of early and midterm atrial arrhythmia.]]></description><subject>Arrhythmias, Cardiac - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Fontan Procedure - methods</subject><subject>Fontan Procedure - mortality</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Morbidity</subject><subject>Postoperative Complications - epidemiology</subject><subject>Pulmonary Artery - surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1vFTEQRS1ERB6Bmg65AdHsi8f7abooChApUpog0VkT72ziyGsvtvdB_j272ieloppizr2aOYx9ALEH0bTnYzZ7KQTsARpVta_YDoRqi6arf71mOyGkLGopy1P2NqUnIUQrQL1hpwCtbDqldmy6-psjGoy9RcNN8P1sMz9QTHPiDjNFdDzP3pPjBg9hmt0YPMbnlfVksg0-ccwcebL-wRG3PmWb53XxlV-PE5rMg-dhziaMlN6xkwFdovfHecZ-fru6u_xR3Nx-v768uClMVbW5ANEqgdBgJauyM1Xd1NQKJWsaZF0OBKoHKImqQQ217GohiaAfEJuO6vtOlmfs89Y7xfB7ppT1aJMh59BTmJNuZQmiA7GA5xtoYkgp0qCnaMflQw1Cr5L1IlmvkvUmeUl8PFbP9yP1L_zR6gJ8OgKYDLohojc2vXBl2ZUS1hu_bNyjfXj8YyPpNKJzSy3op2wSSKkbDRLWSrWhtDg7WIo6GUveUL_ETNZ9sP-99x8pwqfs</recordid><startdate>20011201</startdate><enddate>20011201</enddate><creator>Azakie, Anthony</creator><creator>McCrindle, Brian W.</creator><creator>Van Arsdell, Glen</creator><creator>Benson, Lee N.</creator><creator>Coles, John</creator><creator>Hamilton, Robert</creator><creator>Freedom, Robert M.</creator><creator>Williams, William G.</creator><general>Elsevier Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20011201</creationdate><title>Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes</title><author>Azakie, Anthony ; McCrindle, Brian W. ; Van Arsdell, Glen ; Benson, Lee N. ; Coles, John ; Hamilton, Robert ; Freedom, Robert M. ; Williams, William G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-10790a16a42438c4565e70925ef253fe19d113ee4f9f528502ee1dfaa68e5b823</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Arrhythmias, Cardiac - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Fontan Procedure - methods</topic><topic>Fontan Procedure - mortality</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Morbidity</topic><topic>Postoperative Complications - epidemiology</topic><topic>Pulmonary Artery - surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azakie, Anthony</creatorcontrib><creatorcontrib>McCrindle, Brian W.</creatorcontrib><creatorcontrib>Van Arsdell, Glen</creatorcontrib><creatorcontrib>Benson, Lee N.</creatorcontrib><creatorcontrib>Coles, John</creatorcontrib><creatorcontrib>Hamilton, Robert</creatorcontrib><creatorcontrib>Freedom, Robert M.</creatorcontrib><creatorcontrib>Williams, William G.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azakie, Anthony</au><au>McCrindle, Brian W.</au><au>Van Arsdell, Glen</au><au>Benson, Lee N.</au><au>Coles, John</au><au>Hamilton, Robert</au><au>Freedom, Robert M.</au><au>Williams, William G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2001-12-01</date><risdate>2001</risdate><volume>122</volume><issue>6</issue><spage>1219</spage><epage>1228</epage><pages>1219-1228</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract><![CDATA[Objective: To compare outcomes of extracardiac conduit and lateral tunnel Fontan connections in a single institution over a concurrent time period. Methods: Between January 1994 and September 1998, 60 extracardiac conduit and 47 lateral tunnel total cavopulmonary connections were performed. Age, sex, and weight did not differ between the 2 groups. Compared with the lateral tunnel group (LT group), patients undergoing the extracardiac conduit procedure (EC group) had a trend to a higher incidence of morphologically right ventricle (EC group 48% vs LT group 32%; P <.09), a higher incidence of isomerism/heterotaxy syndrome (EC 22% vs LT 0%; P <.001), worse atrioventricular valve regurgitation (EC 11% moderate-plus vs LT 0%; P <.06), and lower McGoon indices (EC 1.8 ± 0.5 vs LT 2.1 ± 0.5; P <.03). Preoperative arrhythmias, transpulmonary gradients, room air oxygen saturations, ejection fractions, ventricular end-diastolic pressure, and pulmonary artery distortion did not differ between groups. Cardiopulmonary bypass times and fenestration usage were similar in both groups. Results: Overall operative mortality was 5.6% and did not differ between groups. The LT group had a significantly higher incidence of postoperative sinoatrial node dysfunction (45% vs EC group 15%; P <.007), supraventricular tachycardia (33% vs EC group 8%; P <.0009), and need for temporary postoperative pacing (32% vs 12%; P <.01). Median duration of intensive care unit stay (EC 2 days, range 1-10 days, vs LT 2.8 days, range 1-103 days; P <.07) and ventilatory support (EC 1 day, range 0.25-10 days, vs LT 1 day, range 0.25-99 days; P <.03) were all longer in the LT group. Median chest tube drainage (EC 8 days, LT 9 days) was similar in both groups. Follow-up averaged 2.5 ± 1.4 years in the EC group and 2.8 ± 1.9 years in the LT group. There were 2 late deaths. Overall survival is 94% at 1 month, 92% at 1 year, and 92% at 5 years. Late ejection fraction or atrioventricular valve function did not differ between groups. Intermediate follow-up Holter analysis showed a higher incidence of atrial arrhythmias in the LT group (23% vs 7%; P <.02). Multivariable analysis showed that (1) prolonged cardiopulmonary bypass time was the only independent predictor for perioperative mortality, prolonged ventilation and intensive care unit length of stay, and increased time to final removal of chest tube drains and (2) lateral tunnel Fontan connection is an independent predictor of early postoperative and intermediate atrial arrhythmias. Conclusions: Although patients in the EC group were at higher preoperative risk, their outcomes were comparable with those of the LT group. Use of the extracardiac conduit technique for the modified Fontan operation reduces the risk of early and midterm atrial arrhythmia.]]></abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>11726899</pmid><doi>10.1067/mtc.2001.116947</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Arrhythmias, Cardiac - epidemiology Biological and medical sciences Child, Preschool Female Fontan Procedure - methods Fontan Procedure - mortality Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Hospital Mortality Humans Male Medical sciences Morbidity Postoperative Complications - epidemiology Pulmonary Artery - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Treatment Outcome |
| title | Extracardiac conduit versus lateral tunnel cavopulmonary connections at a single institution: Impact on outcomes |
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