The authors report the medium term results of total cavo-pulmonary connections in 50 patients treated between 1988 and 1997.
Population: the cardiac lesions were single ventricle (n = 27), tricuspid atresia (n = 11), mitral atresia (n = 2), pulmonary atresia with intact septum (n = 2) or more complex lesions (n = 8). The mean age at surgery was 75 +/- 6 months. There were no operative deaths but two early reoperations were required. After surgery, oxygen saturation increased from 76 to 91% (p = 0.001). Early complications included: 11 mild cardiac failures, 19 pericordial or pleural effusions and 6 supraventricular arrhythmias. At medium term (average follow-up of 59 months), there were no fatalities and all were in NYHA Classes I and II. Cyanosis was observed in 12 patients: right-to-left atrial shunt (n = 7), 2 of which were closed percutaneously, shunt from the azygos system to the suprahepatic veins in 5 cases with Kawashima, 2 of which were reoperated, pulmonary arterio-venous fistula (n = 3). Six patients had arrhythmias and 3 had regressive thromboses. At the end of follow-up, 8 patients remained cyanotic, 4 had antiarrhythmic therapy and 2 had mild ventricular dysfunction. In conclusion, the results of total cavo-pulmonary connections are satisfactory at short and medium term and may be proposed for patients with complex univentricular cardiac malformations.