Postoperative management of total cavopulmonary correction in patients with single functional ventricle

AIM:To summarize the experiences of postoperative management of total cavopulmonary correction (TCPC) in patients with single functional ventricle. METHODS: Between January 2012 and June 2013, 60 patients with functional univentricular complex congenital heart disease underwent Fontan operation in Beijing Fuwai Hospital. Patients were diagnosed by echocardiogram and angiography. Their mean age was (5.5±1.7) years, weight was (18±4) kg, SpO2 was (80±7)%, preoperative EF was (64±7)%, Nakata index was (371±234) mm2/m2, McGoon ratio was (2.2±0.7), and preoperative PAP was (12±4) mmHg. For better postoperative recovery, pulmonary vascular resistance was reduced, enough capacity load was maintained, myocardial contraction force was increased, arrhythmia was controlled, pleural effusion was properly handled and regular postoperative anticoagulation was applied for the treatment. RESULTS: Cardiopulmonary bypass time was (112±52.4) min, aortic cross-clamping time was 30-52 min and duration of mechanical ventilation was (19±6) h. Postoperative thoracic fluid drainage was (15±12) days, ICU length of stay (LOS) was (5.1±2.1) days and total LOS was (24±12) days. Postoperative low cardiac output syndrome occurred in ten cases. Five cases with acute renal failure were treated with peritoneal dialysis or hemofiltration, of whom two cases died (40%). Intractable pleural effusion (chest drainage >2 weeks) occurred in 20 cases, chylothorax in 25 cases and protein leakage bowel disease in one patient who eventually died of pulmonary infection. Postoperative arrhythmia occurred in four cases and postoperative pulmonary infection in ten cases. Postoperative vena cava pressure significantly dropped after TCPC ［(12±4) vs.(9±3) mmHg, P<0.05］, oxygen saturation markedly improved ［(80±7) vs.(97±4)%, P<0.01］ and hemoglobin returned to normal ［(181±17) vs.(125±29) g/L, P<0.01］. CONCLUSION: Proper postoperative management based on patients’ individual pathophysiological conditions reduces mortality and complications after TCPC.