Current Approach for Cavopulmonary Connection

Bidirectional cavopulmonary anastomosis may either be performed as part of a total cavopulmonary connection or as a palliative procedure in a staged approach towards the Fontan operation. It can be performed primarily in cyanotic patients older than 3 months of age (preferably older than 6 months) or secondarily after a previous systemic to pulmonary artery shunt or a banding of the pulmonary artery o r a Norwood It can be associated with other palliative procedures such as atrioseptectomy, take down of previous systemic to pulmonary artery shunts, patch arterioplasty of stenotic or distorted pulmonary artery, and main pulmonary artery to aorta anastomosis for bypass of subaortic o b s t r ~ c t i o n . ~ ~ ~ Since October 1988, our approach to the Fontan operation is an association, simultaneous or sequential, of BCPA as described previously, and conduit interposition between the transected inferior vena cava (IVC) and RPA.5 The idea came following the work of Puga et a16 with the aim to provide the best pattern of laminar flow from the IVC to the pulmonary tree with a complete extracardiac surgery. We will describe both procedures.