The Effect of Additional Pulmonary Blood Flow on Timing of the Total Cavopulmonary Connectionvan Slooten, Y. J., Elzenga, N. J., van Melle, J. P., Berger, R. M. F., Ebels, T. & Waterbolk, T., Jun-2012, In : Annals of thoracic surgery. 93, 6, p. 2028-2034 8 p.
Research output: Contribution to journal › Article › Academic › peer-review
Background. The staged Fontan procedure is used to palliate functionally univentricular hearts. The effect of additional pulmonary blood flow combined with a bidirectional cavopulmonary shunt in these patients remains a controversial subject.
Methods. This retrospective study included all 82 patients with a unilateral or bilateral bidirectional cavopulmonary shunt at our institution between April 1990 and July 2010. Patients with hypoplastic left heart syndrome were excluded. Two groups, based on the presence (n = 57) or absence (n = 25) of additional pulmonary blood flow after the bidirectional cavopulmonary shunt, were compared.
Results. Patients with a bidirectional cavopulmonary shunt combined with additional pulmonary blood flow had higher arterial oxygen saturations postoperatively (86% [interquartile range, 85% to 90%] vs 82% [80% to 85%]; p = 0.001) and had a longer median interval before the total cavopulmonary connection (3.42 [2.43 to 4.89] years vs 2.90 [2.08 to 3.32] years; p = 0.06). At the total cavopulmonary connection, they were older (4.59 [3.88 to 6.49] years vs 3.94 [3.10 to 4.57] years; p = 0.03) and had a larger median body surface area (0.73 [0.65 to 0.87] m(2) vs 0.68 [0.59 to 0.73] m(2); p = 0.04).
Conclusions. Patients with a bidirectional cavopulmonary shunt and additional pulmonary blood flow have a longer interval before the total cavopulmonary connection without evident untoward effects. This may theoretically be advantageous for the pulmonary artery growth needed for a successful Fontan circulation. Furthermore, postponement of the final Fontan may ensure the insertion of a larger extracardiac conduit to avoid prosthesis-patient mismatch. (Ann Thorac Surg 2012;93:2028-34) (C) 2012 by The Society of Thoracic Surgeons
|Number of pages||8|
|Journal||Annals of thoracic surgery|
|Publication status||Published - Jun-2012|
- BIDIRECTIONAL GLENN PROCEDURE, HEMI-FONTAN OPERATION, SINGLE-VENTRICLE, EARLY REDUCTION, VOLUME WORK, ANASTOMOSIS, COMPLETION, CHILDREN