Total Right Heart Bypass: Long-Term Complications and Survival

María Lafuente, claudia natalia villalba, Marisa Di Santo, Mariela Mouratian, Alberto Sciegata, Ariel Saad, José Alfonso, Juan Laura, Horacio Capelli


IntroductionTotal right heart bypass (RHB) is a palliative procedure with high incidence of complications.Early recognition and individualization of these complications is crucialto define adequate therapeutic strategies.ObjectiveThe aim of this study was to evaluate the incidence of events and mortality in totalRHB during long-term follow-up and compare atriopulmonary (AP) with extracardiacconduit (EC) techniques.MethodsBetween 1987 and 2010, 191 patients submitted to total RHB with a mean follow-up(X) of 6.5 ± 5 years (1-20 years) after surgery were analyzed.Patients were divided, according to the surgical approach, in group I: AP, 39 patients,X=14 years and group II: EC, 152 patients, X=4 years.ResultsThe following complications were present in 57% (n = 116) of patients:Overall long-term mortality was 4.6% (n = 9).At univariate analysis, mortality was associated with ventricular dysfunction(p=0.0000), protein-losing enteropathy (p=0.0000), atrial flutter (p=0.0012), reoperations(p=0.0006), subaortic stenosis (p=0.0024), thrombosis (p =0.01) and APtechnique (p=0.0004).Multivariate analysis revealed that mortality was associated with ventricular dysfunction[OR 27.7 (4.64-165.24); p = 0.0003], AP technique [OR 2.5 (16.2-105.9); p =0.0036] and protein-losing enteropathy [OR 9.31 (1.53-56.66); p = 0.01].


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