High-risk Factors Influencing Early Outcome After Primary Total Cavopulmonary Connection

Objective:Analysis of mortality and morbidity of patients treated by primary total cavopulmonary connection (TCPC), to identify what are High-risk factors influencing the early outcome of patients undergoing primary TCPC.Methods:We divided all 43 patients into Death group(A group) and Survival group(B group),who underwent primary TCPC in our institute between February 2003 and September 2009.Then the survivors were divided into Complication group (B1 group) and Good group (B2 group).According to retrospectively review the medical and surgical records of these group, we analysis the high-risk factors of mortality and morbidity.Results:There were 11 patients died. The mortality was 25.6%. These parameters did not differ between the A group and the B group, such as age, weight, preoperative hemoglobin, preoperative room air oxygen saturation, body surface area, transpulmonary gradients, McGoon index, Nakata index, cardiopulmonary bypass time, aortic clamping time, operation time, time in intensive care unit, mechanical ventilation time, rhythm of the heart, Heterotaxy, the ventricle connected with aorta, the left Glenn operation, the fenestration operation, atrioventricular valve regurgitation and relative operation, pleural drainage time, length of stay, postoperative room air oxygen saturation, and so on (P>0.05).But CVP in A group was much higher than it in B group(20.04±3.47mmH2O vs 14.09±2.66 mmH20;P<0.001);the mortality of patients with unbalance ventricle was lower than those with balance ventricle(14.3% vs 46.7%;P=0.025);and the mortality of the left ventricular morphologic Single ventricle was also lower than the biventricular congenital heart disease's(8.7% vs 46.7%;P=0.018).Although the mortality of extracardiac conduit TCPC was higher than lateral tunnel TCPC (35.5% vs 0%;P=0.019),the McGoon index and Nakata index in the latter operation patients was superior to the former's (P=0.01).Complications occurred in 17 patients, the morbidity was 39.5%.These parameters did not differ between the B1 group and the B2 group, such as age, weight, preoperative hemoglobin, heart rate, preoperative room air oxygen saturation, transpulmonary gradients, body surface area, McGoon index, Nakata index, cardiopulmonary bypass time, aortic clamping time, operation time, time in intensive care unit, mechanical ventilation time, rhythm of the heart, Heterotaxy, the ventricle connected with aorta, the balanced extent of ventricular development, the ventricular morphology, the left Glenn operation, the fenestration operation, atrioventricular valve regurgitation and relative operation, extracardiac conduit TCPC and lateral tunnel TCPC, CVP, postoperative room air oxygen saturation, and so on (P>0.05). But the morbidity in patients younger than 4 years old was higher than 4 to 15-year-old patient's(P=0.013)Conclusion:1.primary TCPC brings about high mortality and morbidity,the staged TCPC may improve early outcome.2.The balanced extent of ventricular development and the station of CVP after operation may have high degree of correlation with mortality of primary TCPC...