Surgical palliation of tricuspid atresia

Abstract

In the 20 year period ending December 31, 1973 we operated on 105 patients for palliation of tricuspid atresia (TA) with reduced pulmonary blood flow. Potts' anastomosis (85), Blalock Taussig anastomosis (19), intrapericardial aorta (Ao) to right pulmonary artery (RPA) (18), Glenn procedure (3) and miscellaneous shunts (2) have been used. Of patients undergoing operation more than 15 years ago, 45% (9/20) are still alive. The over all operative mortality was 9%. It was highest in patients less than one month of age (7/23, 30%). There were no operative deaths in patients older than 12 months. The median age at first operation for the entire series was five months. The results indicate the Potts' anastomosis and Ao to RPA anastomosis are superior to the Blalock Taussig anastomosis (BT) for palliation of TA. Of patients surviving BT, 69% (11/16) required reoperation, compared to 22% (17/78) surviving Potts' anastomosis and 13% (2/16) survivimg Ao to RPA shunts. Operative mortality was 8% (7/85) for Potts' anastomosis, 16% (3/19) for BT, and 11% (2/18) for Ao to RPA shunts. All three patients undergoing Glenn procedures (superior vena cava to RPA anastomosis) required reoperation or died without significant benefit. Balloon atrial septostomy and Potts' anastomosis appear to be indicated for infants less than six months of age, and Ao to RPA shunt with simultaneous atrial septectomy (if indicated) for older children.