Total cavopulmonary connection（TCPC）conversionの中期成績と治療効果

Midterm Outcomes and Therapeutic Effects of Total Cavopulmonary Connection （TCPC） Conversion

Fontan手術は三尖弁閉鎖症の治療として1971年にFontanら1）により報告された方法で，単心室型心疾患のチアノーゼを改善し，容量負荷を軽減することを目的とした機能的根治術として，その後広く認識されている．当初，Fontan循環においては心房収縮が重要と考えられていたため，1980年代後半までは右心耳-肺動脈吻合（atrio-

Total cavopulmonary connection （TCPC） conversion prevents late complications after the atrio-pulmonary-Fontan procedure. However, the outcomes and effects of TCPC conversion are not fully known. We performed TCPC conversion in 31 patients （2004～2017）. Concomitantly, we performed anti-arrhythmia surgery in 28 patients （90％）, atrioventricular valve surgery in 4, and pacemaker implantation in 2. There were no perioperative deaths, but one late death occurred due to protein-losing gastroenteropathy. Five-year survival was 96.8％. Eleven patients were readmitted for various reasons, including arrhythmia in 7 and heart failure in 1. The 5-year cardiac event-free rate was 67.7％. The cardiac index was significantly improved：1.58 l/min/m2 before to 3.57 l/min/m2 after surgery （p＝0.0075）. Surgical and midterm outcomes of TCPC conversion were favorable. In the perioperative and late periods, therapeutic intervention was usually for atrial arrhythmia. This study demonstrated that TCPC conversion is an effective therapeutic procedure.