Improving outcomes of the surgical management of right XXXX .

@entity1 @entity3885 @entity357 @entity299 @entity1146 @entity4032 @entity340
BACKGROUND: @entity1 with right @entity4032 (RAI) have several @entity299 historically resulting in significant morbidity and mortality. We sought to assess whether current surgical strategies have improved the outcomes of @entity1 with RAI. METHODS: A retrospective review of our database from 1997 to 2010 identified 60 consecutive @entity1 with RAI who underwent initial palliation at Mt. Fuji Shizuoka @entity1 's Hospital. All of the @entity1 had a functional single ventricle. Of the 60 @entity1 , 33 @entity1 (51.7%) had @entity3885 (TAPVD), 23 @entity1 (40.3%) had significant (more than moderate) @entity340 ( @entity340 ), 7 @entity1 (12.3%) had @entity357 , and 4 @entity1 (6.7%) had major aortopulmonary collateral arteries. Pulmonary outflow @entity1146 was present in 39 of the @entity1 (65%), and 46 @entity1 had systemic-to-pulmonary artery shunts. Of the 33 @entity1 with TAPVD, 18 underwent repair of the condition at initial palliation, 9 others at the time of a Glenn operation, 2 more through a Fontan operation, and 4 at the interstage between palliative surgeries. Eight of the 23 @entity1 with significant @entity340 underwent @entity340 at initial palliation, 8 others at the time of Glenn operation, 4 others at the time of Fontan operation, and 3 during the interstage between operations. An initial neonatal surgical procedure was performed in 30 @entity1 (50%). The mean follow-up period for @entity1 in the study was 53.1 months. RESULTS: Operative mortality after initial palliation was 15.4% (4 of 26 @entity1 ) before 2003 and 17.6% (6 of 34 @entity1 ) after 2004 (p=NS). Five-year survival was 53.8% before 2003 and 81.7% after 2004 (p=0.035, log-rank test). A multivariate analysis identified persistent @entity340 of more than moderate degree (p=0.04) as a factor associated with late mortality. CONCLUSIONS: The outcomes of surgery for RAI are improving. Neonatal palliative surgery for RAI carries a high operative risk of early mortality, and persistent significant @entity340 remains a risk factor for late mortality.
