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Right arrow Congenital - cyanotic

Ann Thorac Surg 2006;82:1260-1266
© 2006 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Early Cavopulmonary Anastomosis After Norwood Procedure Results in Excellent Fontan Outcome

Robert D.B. Jaquiss, MDa,b,*, Stephanie L. Siehr, BSa, Nancy S. Ghanayem, MDb,c, George M. Hoffman, MDb,d, Raymond T. Fedderly, MDb,e, Joseph R. Cava, MD, PhDb,e, Kathy A. Mussatto, RN, BSNb, James S. Tweddell, MDa,b

a Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
c Division of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
d Division of Pediatric Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
e Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin
b Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Accepted for publication April 27, 2006.

* Address correspondence to Dr Jaquiss, 800 Marshall St, Slot 677, Little Rock, AR 72202 (Email: rjaquiss{at}uams.edu).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: Children with univentricular hearts and aortic arch obstruction are treated sequentially with Norwood procedure, superior cavopulmonary anastomosis (SCPA), and Fontan operation. Early SCPA results in lower initial O2 saturation and longer hospitalization, but not increased mortality. We sought to determine the impact of early SCPA on Fontan candidacy and outcomes.

METHODS: Eighty-five consecutive patients undergoing Norwood operation between January 1998 and February 2003 were divided into group 1 (SCPA at less than 4 months, n = 33) and group 2 (SCPA at more than 4 months, n = 52). Of the original cohort, 69 have undergone Fontan operation, 7 await Fontan, 1 was transplanted, 3 are not Fontan candidates, and 5 died late after SCPA. Group 1 (n = 25) and group 2 (n = 44) patients who have completed Fontan operation were compared for preoperative and perioperative variables: age, size, O2 saturation, pulmonary artery pressure and size, prevalence of tricuspid regurgitation and ventricular dysfunction, extubation rate in operating room, duration of pleural drainage, hospital stay, and discharge O2 saturation. Late functional status and ventricular function were also compared. Survival was compared for original groups 1 and 2.

RESULTS: There were no differences for any preoperative or perioperative variable, or late functional assessment. Actuarial survival at 6 years was also not different (88% ± 5% for group 1 and 94% ± 4% for group 2, p= 0.72).

CONCLUSIONS: Although initially more cyanotic and hospitalized longer than older peers, younger SCPA patients achieve clinical equivalence by the time of Fontan operation and afterward. We conclude that both short- and long-term outcomes support performance of early SCPA.




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