Avoiding cardiopulmonary bypass in extracardiac cavopulmonary connection: does it really matter?

Abstract

Objectives: We examined the effect of avoiding cardiopulmonary bypass on the early outcome variables after fenestrated extracardiac total cavopulmonary connection.

Methods: Between May 2001 and January 2009, 102 patients with univentricular heart physiology underwent fenestrated extracardiac total cavopulmonary connection. Patients were divided into one of 2 groups: the cardiopulmonary bypass (n = 48) group and the no cardiopulmonary bypass (n = 54) group. In both groups there were patients with primary and staged fenestrated extracardiac total cavopulmonary connection. Duration of mechanical ventilation, pleural effusion, hemodynamic status, incidence of arrhythmia, and mortality were compared between the 2 groups.

Results: Both groups were matched, except for more cases of tricuspid atresia in the no cardiopulmonary bypass group (P = .014) compared with other diagnostic morphologies and higher preoperative hemoglobin levels in the no cardiopulmonary bypass group (P = .01). Avoiding cardiopulmonary bypass did not reveal any significant effect on postoperative outcomes. A cardiopulmonary bypass time of more than 120 minutes caused not only a meaningful increase in the mean of mechanical ventilation duration (35 +/- 9.6 vs 13 +/- 2.1 hours, P = .026) but also increased the incidence of mechanical ventilation for more than 12 hours (P = .04). Bypass time of more than 120 minutes did not have influence on any other postoperative variables.

Conclusion: Avoiding cardiopulmonary bypass in fenestrated extracardiac total cavopulmonary connection had no direct effect on the early outcome variables.