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World-wide experience with the use of two-directional cavopulmonal anastomosis (TDCPA) for the surgical treatment of congenital heart failure (CHF) is summarized together with the results of analysis of immediate and late outcomes of this operation. It is concluded that TDCPA in certain complex forms of CHF and in patients at risk of poor outcome of Fontan surgery may be used as the final stage of hemodynamic correction.

Treatment of patients with complex cyanotic congenital heart disease is one of the most difficult problems in heart surgery. In a number of cases, when normal introcardiac hemodynamics is impossible to reestablish, the operation of choice consists in hemodynamic correction, which implies excluding the right heart from pulmonary circulation by rerouting venous blood directly to the lungs. The analysis of the outcomes of the operation, performed in various modification, shows that the most optimal method to date is extracardial bypass of the right heart with a valveless tubular prosthesis. This method is associated with a relatively rare early and long-term complications. Improvement of outcomes can be achieved mainly via dividing the correction procedure into stages, including bidirectional cavapulmanal anastomosis, and via thorough selection and preoperative preparation of patients.