Total right ventricular exclusion procedure: An operation for isolated congestive right ventricular failure

Shunji Sano, Kozo Ishino, Masaaki Kawada, Shingo Kasahara, Takushi Kohmoto, Mamoru Takeuchi, Shin Ichi Ohtsuki

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objective: To prevent possible deleterious effects of right ventricular volume overload on cardiorespiratory function, we developed a total right ventricular exclusion procedure for the treatment of end-stage isolated congestive right ventricular failure. Methods: Since 1996, this procedure has been performed in 5 patients in New York Heart Association functional class IV: 2 adults with arrhythmogenic right ventricular dysplasia and 3 children with Ebstein anomaly. The entire right ventricular free wall was resected along the atrioventricular groove and then parallel to the interventricular septum, sparing the pulmonary valve and a skeletonized right coronary artery. The orifice of the tricuspid valve was closed with either a polytetrafluoro- ethylene patch or with its leaflets. The defect of the right ventricular free wall was covered with a polytetrafluoroethylene patch in the 2 patients with arrhythmogenic right ventricular dysplasia and directly closed with the remnant of the free wall in the 3 children with Ebstein anomaly. After resection of a redundant right atrial wall, coronary sinus blood flow was rerouted into the left atrium through an atrial septal defect. A total cavopulmonary connection was constructed in 4 patients and a bidirectional superior cavopulmonary anastomosis in 1 infant. The heart was controlled with a DDD pacemaker in 3 patients. Results: The patients were extubated at a mean of 14 hours postoperatively (range, 1-38 hours). There were no early or late deaths. At follow up, ranging from 8 to 57 months, the mean cardiothoracic ratio had decreased from 74% ± 7% before the operation to 52% ± 6% (P < .01). All patients are in functional class I. Neither of the patients with arrhythmogenic right ventricular dysplasia have had attacks of ventricular tachycardia nor are they using antiarrhythmic medication. Conclusions: The total right ventricular exclusion procedure provides effective decompression of the lung, as well as the left ventricle, and may result in more effective volume loading of a surgically created single ventricle with increased systemic output. We believe that this new surgical option offers rescue treatment for isolated end stage right ventricular failure in critically ill patients.

Original languageEnglish
Pages (from-to)640-647
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume123
Issue number4
DOIs
Publication statusPublished - Jan 1 2002

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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