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Long-term results of total cavopulmonary connection with low ejection fraction

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Abstract

Purpose

The aim of this study was to investigate the surgical outcomes and change in cardiac performance after total cavopulmonary connection (TCPC) in patients with reduced ventricular ejection preoperatively.

Methods

Among the 195 patients undergoing TCPC between 1990 and 2001 were 52 who had a preoperative ejection fraction of ≤50% (30%–50%, mean 44%). A dominant ventricle was of the morphologically right type in 81% of patients.

Results

A total of 9 of the 52 patients died early. Two patients died in the intermediate term. Postoperative exercise testing showed maximum oxygen uptake of 26.4 ± 5.8 ml/kg/min (anaerobic threshold 18.3 ± 3.2 ml/kg/ min). The cardiac index was 3.1 ± 0.9 l/min/m2 at 1 year after TCPC, with no fundamental change at 5 years (3.1 ± 0.8 l/min/m2). The end-diastolic volume of the dominant ventricle was 130% ± 74% of the anticipated normal value at 1 year and 93% ± 27% at 5 years after TCPC, with ejection fractions of 48% ± 13% and 49% ± 9%, respectively. When these parameters were plotted for the individual patients, the ejection fraction increased during the first postoperative year, with the percent end-diastolic volume decreasing in 31 survivors; the trend appeared atypical in the remaining 12 survivors. Even in these patients, however, the parameters eventually changed toward favorable circumstances 5 years after TCPC.

Conclusion

Change in ventricular function was not necessarily pessimistic after TCPC in patients with reduced ventricular contraction preoperatively.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Shuichi Shiraishi, Koji Kagisaki, Ikuo Hagino, Junjiro Kobayashi & Toshikatsu Yagihara

  2. Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, UK

    Hideki Uemura

  3. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan

    Masashi Takahashi

Authors
  1. Shuichi Shiraishi
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  2. Hideki Uemura
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  3. Koji Kagisaki
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  4. Ikuo Hagino
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  5. Junjiro Kobayashi
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  6. Masashi Takahashi
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  7. Toshikatsu Yagihara
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Correspondence to Shuichi Shiraishi.

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Shiraishi, S., Uemura, H., Kagisaki, K. et al. Long-term results of total cavopulmonary connection with low ejection fraction. Gen Thorac Cardiovasc Surg 59, 686–692 (2011). https://doi.org/10.1007/s11748-011-0812-2

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  • DOI: https://doi.org/10.1007/s11748-011-0812-2

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