CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
17
320: MID-TERM OUTCOME OF EXTRACARDIAC FONTAN
OPERATION USING CONTEGRA CONDUIT
Arif Hussain, Deraz Salem, Amin Muhammed Arfi, Masroor Hussain
Sharfi, Muhamed Ismail Fouad, Ghassan Baslaim
King Faisal Specialist Hospital and Research Centre, Saudi Arabia
Background:
Reports have shown increased risk of thrombotic
occlusion of Fontan circulation with the use of a Contegra conduit.
We intended to retrospectively compare the outcome of Fontan
completed using a Contegra conduit with those using a Dacron tube.
Methods:
Medical records, echocardiograms and catheterisation
data of all patients undergoing Fontan completion from 2002 to 2010
were reviewed. The outcome of the Contegra group was compared
with those of the Dacron tube group. All patients were anticoagu-
lated using heparin in the immediate postoperative period and later
with coumadin to maintain therapeutic INR. The primary outcome
was the prevalence of thrombotic complications and survival in the
two groups. Chi-square analysis was used to compare the categorical
variables. Independent two samples
t
-test was used to compare the
pre- and post-operative variables. Log-rank test was performed and
Kaplan-Meier curves were generated to compare primary outcomes
in the two groups.
Results:
Seventy-six patients underwent the Fontan procedure, with
Contegra conduit (
n
=
47) and Dacron tube (
n
=
29). The two groups
were matched with regard to demographic variables, pre-operative
haemodynamic data, intra-operative and postoperative outcomes.
Within 30 days, thrombotic complications occurred in 6/47 (13%)
in the Contegra and 3/29 (10%) in the Dacron groups (
p
=
0.983).
Relative risk of thrombosis in the Contegra group was 0.949 (95% CI
=
0.8–1.3). The mean follow up for the whole group was 87 months
(Contegra
=
70, Dacron
=
95) (
p
=
0.304). Nine patients died: 7/47 in
the Contegra and 2/28 in the Dacron groups (
p
=
0.486). The relative
risk of dying in the Contegra group was 0.909 (95% CI
=
0.8–1.1).
Conclusion:
This is so far the largest series evaluating the outcome
of extra-cardiac Fontan procedure using a Contegra conduit. Our
results suggest that using a Contegra conduit for Fontan comple-
tion does not increase the risk of thrombotic complications or death
compared to a Dacron tube.
335: PLASMA EXCHANGE FOR CARDIOGENIC SHOCK IN
DILATED CARDIOMYOPATHY
Keiichi Koizumi
1
, Hiroaki Kise
1
, Takako Toda
1
, Youhei Hasebe
1
,
Kenichi Matsuda
2
, Kanji Sugita
1
, Minako Hoshiai
1
1
Department of Paediatrics, Faculty of Medicine, University of
Yamanashi, Japan
2
Department of Emergency and Critical Care Medicine, University
of Yamanashi, Japan
Background:
Auto-immunity is suggested as one of the causes of
dilated cardiomyopathy (DCM). The sera of many patients with
DCM are positive for several antibodies directed against cardiac anti-
gens. These antibodies play a role in the pathophysiology of cardiac
dysfunction. We performed slow plasma exchange plus continuous
haemodiafiltration (SPE+CHDF) to eliminate these antibodies for
a DCM patient with cardiogenic shock, using extracorporeal life
support (ECLS).
Case
presentation:
He was diagnosed with idiopathic DCM at two
years of age. His heart failure became gradually worse. He began
oral administration of carvedilol from six years of age, however, the
heart failure worsened (NYHA III). Left ventricular ejection frac-
tion (LVEF) was reduced to 28%. At the age of 13 years, he rapidly
deteriorated and developed multiple organ failure. His antibeta-1
adrenergic receptor antibody titre and anti-muscarinic M2 receptor
antibody titre were 80 times the background density on enzyme-
linked immunosorbent assay. We planned to register for heart trans-
plantation and performed ECLS using a combination of SPE+CHDF
in order to rescue him. Daily PE with CHDF was performed for
two days. PE was performed over eight hours, using 1.2 times the
circulating plasma volume of fresh frozen plasma. After SPE+CHDF,
his blood pressure and LVEF were dramatically improved. He could
discontinue catecholamine infusion and end the ECLS in three days.
He had no complications during SPE+CHDF.
Conclusion:
A patient with DCM using ECLS for cardiogenic
shock could be weaned from the ECLS by performing SPE+CHDF.
In patients with DCM, SPE+CHDF treatment for elimination of
antimyocardial antibody is very effective and useful for improving
cardiac function. This therapy is a new strategy for helping patients
recover from heart failure in DCM.
339:A 20-YEAR COMPARISON OF SIMPLEAND COMPLEX
TAPVR
Parth Patel, John Brown, Mark Rodefeld, Mark Turrentine
Indiana University School of Medicine, Indiana, USA
Background
: Total anomalous pulmonary venous return (TAPVR)
frequently requires neonatal surgery. Two of the largest determi-
nants of surgical timing and mortality in TAPVR patients are other
complex cardiac lesions and/or pre- or postoperative pulmonary vein
obstruction (PVO). Simple TAPVR refers to TAPVR associated with
an ASD and/or PDA, and complex TAPVR refers to TAPVR associ-
ated with other complex cardiac lesions. In this study we compared
our outcomes with simple and complex TAPVR with a focus on the
influence of pulmonary vein obstruction on the outcomes.
Methods
: Since 1966, 216 children have undergone simple and
complex TAPVR repair at our institution. The first 105 were previ-
ously reported. This study reviews the most recent 111 patients from
1990 to 2011. The mean age was 5.2 months, ranging from one day to
16 years. Sixty-one of the patients had simple TAPVR and 50 (45%)
had complex TAPVR.
Results
: Early and late mortality was at 1.6 and 6.6%, respectively,
in the simple TAPVR group and 14 and 18%, respectively, in the
complex TAPVR patients. Pre-operative PVO was more frequent
in the complex than in the simple TAPVR group (36 vs 23%).
Re-intervention rate for postoperative PVO was also higher in the
complex than in the simple TAPVR group (12 vs 7%). Pre-operative
PVO occurred at a higher rate in mixed-type TAPVR patients and
was lowest in cardiac-type TAPVR patients. Re-intervention for post-
operative PVO was highest for the infracardiac TAPVR group and
lowest in the supracardiac TAPVR group. Other risk factors for poor
outcomes were low birth weights, young age, need for pre-operative
ECMO, and single-ventricle physiology.
Conclusions
: Outcomes for simple TAPVR were quite favorable.
Complex TAPVR with and without pulmonary vein obstruction
remains a vexing problem. Improving the management of PVO is the
key to improving outcomes.
348: A COMPARISON OF BLALOCK-TAUSSIG SHUNTS
WITH AND WITHOUT CLOSURE OF THE DUCTUS ARTE-
RIOSUS IN NEONATES WITH PULMONARY ATRESIA AND
INTACT VENTRICULAR SEPTUM
Martin Zahorec, Zuzana Hrubsova, Peter Skrak, Rudolf Poruban,
Lubica Kovacikova
Paediatric Cardiac Centre, National Institute of Cardiovascular
Diseases, Limbova 1, Bratislava, Slovakia
Background:
Neonates with pulmonary atresia and intact ventricu-
lar septum (PA IVS) who have a right ventricle that is deemed not
suitable for decompression undergo single-ventricle palliation. Early
survival after the modified Blalock-Taussig shunt (MBTs) for these
infants is disproportionately low compared with other lesions. The
aim of this report was to compare the results of closure versus non-
closure of the patent ductus arteriosus (PDA) during MBTs surgery
in neonates with PA IVS.
Methods:
This retrospective study included neonates with PA IVS
who underwent a single-ventricle pathway with primary MBTs
through a sternotomy approach at a single institution between
January 2000 and May 2012. Postoperative hospital mortality, need
