Eva van den Bosch1,2,3, Sjoerd S M Bossers1,2, Ad J J C Bogers4, Daniëlle Robbers-Visser5, Arie P J van Dijk6, Jolien W Roos-Hesselink7, Hans M P J Breur8, Felix Haas9, Livia Kapusta10,11, Willem A Helbing1,2,11. 1. Division of Paediatric Cardiology, Department of Paediatrics, Erasmus University Medical Center, Rotterdam, Netherlands. 2. Department of Radiology, Erasmus University Medical Center, Rotterdam, Netherlands. 3. Netherlands Heart Institute, Utrecht, Netherlands. 4. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. 5. Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands. 6. Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands. 7. Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands. 8. Department of Paediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands. 9. Department of Paediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, Netherlands. 10. Paediatric Cardiology, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel. 11. Division of Paediatric Cardiology, Department of Paediatrics, Radboud University Medical Center, Nijmegen, Netherlands.
Abstract
OBJECTIVES: Our goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit. METHODS: We included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias). RESULTS: Of the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5-16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14). CONCLUSIONS: A comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.
OBJECTIVES: Our goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit. METHODS: We included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias). RESULTS: Of the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5-16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14). CONCLUSIONS: A comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.
Authors: Eva van den Bosch; Sjoerd S M Bossers; Vivian P Kamphuis; Eric Boersma; Jolien W Roos-Hesselink; Johannes M P J Breur; Arend D J Ten Harkel; Livia Kapusta; Beatrijs Bartelds; Arno A W Roest; Irene M Kuipers; Nico A Blom; Laurens P Koopman; Willem A Helbing Journal: J Am Heart Assoc Date: 2021-02-24 Impact factor: 5.501