Does A Complete Extracorporeal Circulation Free Approach To Patients With Univentricular Hearts Leads To Superior Early Outcomes ?
Sachin Talwar, Neeti Makhija, Vishnubhatla Sreenivas, Shiv Kumar Choudhary, Balram Airan.
All India Institute of Medical Sciences, New Delhi, India.
Objective(s): We compared the early outcomes of patients undergoing Extracardiac Total cavopulmonary connection (TCPC) with or without cardiopulmonary bypass (CPB).
Methods: Between February 2012 and April 2018, 110 patients undergoing TCPC without CPB (off-pump group) were compared with equally matched 126 patients undergoing TCPC on CPB (on-pump group). Outcome parameters studied were inotropic score, time to extubation, intensive care unit stay(ICU), mediastinal drainage in ICU, average pleural drainage, time to removal of chest tubes, total hospital stay, saturation at discharge and costs.
Results: There were one early death in the off-pump group and two deaths in the on-pump group. No patient required conversion from off CPB to CPB. The inotropic score (4.2±3.78versus 11.2±64.86, p=0.026), time to extubation (4.65±7.26 versus 13.2±9.16 hours, p=0.013), first 12 hours mediastinal drainage in ICU (478±167.4 versus 836 ±135.9 ml, p=0.03) and ICU stay (1.1±0.47 versus 2.3±2.28 days, p=0.002) were significantly less in the off pump group as compared to on-pump group and saturation at discharge (99.6±0.58 versus 98.3±3.46, p=0.02) was higher in the off-pump group. However the average daily pleural drainage, time to removal of chest tubes and the total hospital stay were no different. There were substantial savings in costs in patients undergoing TCPC without CPB.
Conclusions:
TCPC without CPB is easy to perform, and provides better early post-operative outcomes as compared to TCPC on CPB. With appropriate modifications, this operation can be performed in nearly all patients who do not need an associated intracardiac procedure.
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