Bi-directional cavopulmonary shunt: is accessory pulsatile flow, good or bad? (original) (raw)

1999, European Journal of Cardio-Thoracic Surgery

Objective: Evaluation of the effect and long-term outcome of accessory pulsatile blood¯ow versus classical bi-directional cavopulmonary connection (BCPC). Methods: Retrospective review of the medical and surgical records. Results: Two-hundred and ®ve patients (119 boys, 86 girls) underwent BCPC from 1990 to 1996. Accessory pulsatile¯ow was present in 68%,¯ow being maintained through the pulmonary trunc in 46%, systemic-to-pulmonary artery shunt in 13% and mixed in 7%, or patent ductus arteriosus in 2%. Patients with accessory pulsatile¯ow had lower hospital mortality (3% versus 5%), while mean pulmonary artery pressure (14.1 versus 12.6 mmHg P 0:050) and increase of oxygen saturation (12.4 versus 8.7, P 0:034) were signi®cantly higher. The period of arti®cial ventilation (1.9 day) and ICU stay (6 days) did not differ for both groups. Late mortality was higher following accessory pulsatile¯ow (6% versus 1%). At late follow-up patients with accessory pulsatile¯ow had signi®cantly higher oxygen saturation (mean 85^4%, versus 79^4%; P # 0:005). If subsequent completion of Fontan is considered the optimal palliation and subsequent systemic to pulmonary artery shunt, arteriovenous ®stula and transplantation is considered a failure, patients with accessory pulsatile¯ow had signi®cantly more and earlier completion of the Fontan procedure (mean 1:7^2:4 years, versus 2:7^4:4 years; P 0:008). Survival is not in¯uenced by age at bi-directional cavopulmonary shunt surgery, left or right functional ventricular anatomy or previous palliative surgery. One patient with accessory pulsatile¯ow developed systemic-to-pulmonary collateral's eventually requiring lobectomy. Conclusion: Despite two different initial palliative techniques the outcome was not signi®cantly different. Accessory pulsatile blood¯ow appeared not to be a contra-indication for a completion Fontan procedure. Moreover, the data suggest that after accessory pulsatile¯ow can safely be performed, at late follow-up oxygen saturation is higher, while, signi®cantly more and earlier completion of Fontan occurred. Age at bi-directional cavopulmonary shunt, basic left or right ventricular anatomy or previous palliative surgery did not in¯uence survival.