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Master Thesis

La dérivation cavopulmoniare totale extracardiaque par étapes : étude rétrospective monocentrique : résultats à court et moyen termes

Abstract : Since its description in 1990, the Extra-Cardiac Total Cavopulmonary Connection (EC-TCPC) performed after a bidirectionnal superior cavopulmonary shunt, has become the standard surgical procedure for univentricular hearts. In the past years, mortality has decreased a lot. Nowadays, the issues concerning the patients are longevity, quality of life and functionnal status. The main objective of this study was to identify preoperative and surgical factors associated to long-term functionnal status. The secondary objectives were to identify, among these factors, those which were associated to post-operative morbidity. Between january 1999 and december 2014, 165 patients who went through two stages EC-TCPC, performed in two centers of pediatric cardiac surgery (Bordeaux and Marseille) were retrospectively reviewed. Mean age was 10.2 ± 6.4 years (2,2-34). Long term NYHA status was better for patients with left type single ventricle com! pared to those with right type single ventricle.(p=0,019). Age of 11 at EC-TCPC appeared to be a prognostic threshold beyond which long-term functionnal status was worse (p=0,017). Nakata index was a prognosis factor associated to length of pleural drainage (p=0,03) and hospital length of stay (p=0,03). CPB time was correlated to a longer lenfth of stay in intensive care unit (p<0,001), longer pleural drainage (p<0,001) and hospital length of stay (p<0,001). Preoperative aortopulmonary collareral embolization was associated to shorter length of stay in intensive care unit (p=0,18) and in hospital (p=0,03). EC-TCPC surgery has low mortality and long-term functionnal status is satsfactory. The quality of evolution seems associated to postoperative morbidity factors. These factors also appears to be linked to some preoperartive and surgical factors that can be used as warning.
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Master Thesis
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Submitted on : Wednesday, October 21, 2015 - 3:41:27 PM
Last modification on : Wednesday, August 23, 2017 - 4:40:16 PM
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Alexandre Métras. La dérivation cavopulmoniare totale extracardiaque par étapes : étude rétrospective monocentrique : résultats à court et moyen termes. Médecine humaine et pathologie. 2015. ⟨dumas-01218671⟩

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