Midterm Prognosis and Effectiveness of Fontan Procedure with Total Cavopulmonary Connection Performed in Adults

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  • Ishii Taku
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Yoshikawa Tadahiro
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Yazaki Satoshi
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Kobayashi Takumi
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Kishiki Kanako
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Inage Akio
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Hamamichi Yuji
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Ueda Tomomi
    Department of Pediatric Cardiology, Sakakibara Heart Institute
  • Wada Naoki
    Department of Cardiovascular Surgery, Sakakibara Heart Institute
  • Ando Makoto
    Department of Cardiovascular Surgery, Sakakibara Heart Institute
  • Takahashi Yukihiro
    Department of Cardiovascular Surgery, Sakakibara Heart Institute

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Other Title
  • 成人期にtotal cavopulomonary connectionによるFontan手術を施行した症例の中期成績と効果の検討

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<p>Background: This study aimed to ascertain midterm prognosis by comparing adult and child patients while accounting for the risk factors of complications and the effectiveness of the total cavopulmonary connection (TCPC) procedure.</p><p>Method: We analyzed data for 25 patients aged 18 or older who underwent TCPC procedure. The data for 75 patients aged 5 years or lower were analyzed for comparing the results.</p><p>Results: We observed perioperative complications in 13 patients including one perioperative death. The overall 5-year survival ratio after performing the TCPC procedure in adults was 96.0％, which was not different from that in child patients. On the contrary, cardiac events after discharge occurred more frequently in adult patients. Three patients died after performing the Fontan procedure in the observation period, all of whom had high end-diastolic pressure of the main ventricle and high pulmonary artery pressure. Cardiac events after discharge occurred more frequently among the patients with heterotaxy. Supraventricular tachyarrhythmia occurred more frequently after conducting the TCPC procedure in adult patients than in child patients both in the hospital and after discharge. Percutaneous oxygen saturation and cardiothoracic ratio improved significantly after the Fontan procedure; however, the mean cardiac index remained low at 1.9 L/min/m2．</p><p>Conclusion: The overall survival after performing the Fontan procedure with TCPC was satisfactory in adults. TCPC improved cyanosis and reduced volume overload in adult patients. However, certain patients may develop supraventricular tachyarrhythmia, and some may have high central venous pressure and low cardiac output after the surgery.</p>

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