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The Annals of Thoracic Surgery, Vol 38, 447-457, Copyright © 1984 by The Society of Thoracic Surgeons
DC Cleveland, JK Kirklin, DC Naftel, JW Kirklin, EH Blackstone, AD Pacifico and LM Bargeron Jr
Despite increasing experience with the surgical treatment of tricuspid
atresia, controversy exists regarding the early and late results of the
various surgical options. Between January 1, 1967, and September 1, 1982,
92 patients underwent 147 operations for tricuspid atresia. Eighty-five
patients underwent 1 or more palliative operations (108 procedures), with 8
hospital deaths (9%; confidence limits [CL], 6 to 14%). Thirty-eight
patients underwent 44 classic (Blalock-Taussig or Gore-Tex) shunts, with 3
early (7%; CL, 3 to 13%) and 3 late deaths. Actuarial survival at 5 years
was 78%, but only 56% were alive and free from having to undergo further
operation at 5 years. Thirty-seven patients underwent a Fontan procedure,
with 5 hospital deaths (14%; CL, 8 to 22%). Of these 37 patients, 34 (92%)
had a nonvalved connection between the right atrium and the right
ventricular infundibulum or the pulmonary artery. Incremental risk factors
for hospital mortality after the Fontan procedure in patients with
tricuspid atresia as well as other cardiac anomalies include young age (p =
0.0003), diagnosis other than tricuspid atresia (p = 0.03), and complex
associated procedures (p = 0.02). During the year 1983, hospital mortality
was 7% (1 out of 14; CL, 1 to 22%) for the Fontan procedure without complex
additional procedures. Actuarial survival after a Fontan procedure was 71%
at 5 years, with 3 patients requiring late reoperation. Of the survivors,
96% are in New York Heart Association Functional Class I or II. The Fontan
procedure without a valve offers good intermediate survival, good
functional results, and few reoperations. In patients with diminished
pulmonary blood flow, a classic shunt also provides good palliation and
good intermediate survival, but there is a necessity for additional
operations in many patients within 5 years.
ARTICLES
Surgical treatment of tricuspid atresia
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