TY - JOUR
T1 - Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts
AU - Schreiber, Christian
AU - Cleuziou, Julie
AU - Cornelsen, Juliane K.
AU - Hörer, Jürgen
AU - Eicken, Andreas
AU - Lange, Rüdiger
PY - 2008/9
Y1 - 2008/9
N2 - Objective: Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional cavopulmonary connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development. Methods: Between 2001 and 2006 a total of 124 patients had completion to a total cavopulmonary connection (TCPC). Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA). Results: Mean age at BCPC was 12.6 ± 15.3 months. Mean age at time of TCPC was 31.3 ± 18.7 months, with an interval of 18.6 ± 11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p < 0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5 mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9 mmHg prior to TCPC (p = 0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p = 0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p < 0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p < 0.01). The left PA also increased in size, although this was not statistically significant. Conclusions: After BCPC without additional blood flow, hemodynamic findings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.
AB - Objective: Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional cavopulmonary connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development. Methods: Between 2001 and 2006 a total of 124 patients had completion to a total cavopulmonary connection (TCPC). Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA). Results: Mean age at BCPC was 12.6 ± 15.3 months. Mean age at time of TCPC was 31.3 ± 18.7 months, with an interval of 18.6 ± 11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p < 0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5 mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9 mmHg prior to TCPC (p = 0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p = 0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p < 0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p < 0.01). The left PA also increased in size, although this was not statistically significant. Conclusions: After BCPC without additional blood flow, hemodynamic findings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.
KW - Bidirectional cavopulmonary connection
KW - Congenital heart disease
KW - Partial cavopulmonary connection
KW - Total cavopulmonary connection
UR - http://www.scopus.com/inward/record.url?scp=49149129482&partnerID=8YFLogxK
U2 - 10.1016/j.ejcts.2008.04.043
DO - 10.1016/j.ejcts.2008.04.043
M3 - Article
C2 - 18534863
AN - SCOPUS:49149129482
SN - 1010-7940
VL - 34
SP - 550
EP - 555
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 3
ER -