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Ann Thorac Surg 1997;64:285
© 1997 The Society of Thoracic Surgeons

Correspondence

Extracardiac Total Cavopulmonary Connection Without Cardiopulmonary Bypass

Khalid E. Al-Ebrahim, FRCSC, Hussein Shafei, FRCS(CITh)

Department of Cardiac Surgery, Al Hada Armed Forces Hospital, Taif, Saudi Arabia.

To the Editor:

We read with interest the articles [1–5] written about the extracardiac lateral tunnel operation as the latest and finest modification of the Fontan operation. We have used initially in our experience the intraatrial pericardial conduit [6] for inferior vena cava diversion instead of the more popular polytetrafluoroethylene composite tunnel, but we are convinced now that the extracardiac lateral tunnel operation using pericardium or polytetrafluoroethylene combined with the bidirectional Glenn shunt is the procedure of choice in patients with complex congenital heart diseases requiring the Fontan circulation.

Several advantages have been reported [2, 4] when employing this procedure including maintaining the streamlined laminar flow with the lowest pressure head loss and more favorable energy transfer to the pulmonary circulation [1, 2], thus reducing the incidence of dysrhythmias, baffle obstruction of the pulmonary veins or the atrioventricular valves, intraatrial leaks, thrombosis, and thromboembolism. Also, growth potential of the tunnel is maintained as part of the lateral atrial wall is incorporated into the tunnel [4]. The main operative advantage of this technique is avoidance of aortic cross-clamping and atrial incisions [2, 4], and we have found that this technique can even be performed without bypass by using cavoatrial shunts in selected patients, thus avoiding all risks and complications of cardiopulmonary bypass and making another step toward cost containment and less invasive cardiac operations.

References

  1. Marcelletti C, Corno A, Giannico S, et al. Inferior vena cava--pulmonary artery extracardiac conduit: a new form of right heart bypass. J Thorac Cardiovasc Surg 1990;100:228–32.[Abstract]
  2. Black MD, van Son JAM, Haas GS. Extracardiac Fontan operation with adjustable communication. Ann Thorac Surg 1995;60:716–8.[Abstract/Free Full Text]
  3. Giannico S, Corno A, Marino B, et al. Total extracardiac right heart bypass. Circulation 1992;86(Suppl 2):110–7.
  4. Laschinger JC, Redmond JM, Cameron DE, et al. Intermediate results of the extracardiac Fontan procedure. Ann Thorac Surg 1996;62:1261–7.[Abstract/Free Full Text]
  5. Van Son JAM, Reddy VM, Hanley FL. Extracardiac modification of the Fontan operation without the use of prosthetic material. J Thorac Cardiovasc Surg 1995;110:1766–8.[Free Full Text]
  6. Raffa H, Sorefan AA, Sorefan M, Rustom M, Al Ebrahim K. Total cavopulmonary connection using intra-atrial pericardial conduit "The channel Tunnel operation" a new modification. SHJ 1991;2:70–8.



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