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Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation

Published online by Cambridge University Press:  10 September 2018

Shuichi Shiraishi ,
Toshihide Nakano ,
Shinichiro Oda  and
Hideaki Kado
Shuichi Shiraishi*
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Toshihide Nakano
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Shinichiro Oda
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Hideaki Kado
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
*
Author for correspondence: S. Shiraishi, MD, Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, 5-1-1 Kashii Teruha, Higashi-ku, Fukuoka 813-0017, Japan. Tel: +81-92-682-7000; Fax: +81-92-682-7300; E-mail: [email protected]
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Abstract

Backgrounds

The aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection.

Methods

We conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67).

Results

The proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044).

Conclusions

Early bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

Keywords

Bidirectional cavopulmonary anastomosistiming of operationpost-operative haemodynamics
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1436 - 1443
Copyright
© Cambridge University Press 2018 

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References

1. Cleuziou, J, Schreiber, C, Cornelsen, JK, Hörer, J, Eicken, A, Lange, R. Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months. Eur J Cardiothorac Surg 2008; 34: 556–562.Google Scholar
2. Jacobs, ML, Rychik, J, Rome, JJ, et al. Early reduction of the volume work of the single ventricle: the hemi-Fontan operation. Ann Thorac Surg 1996; 62: 456–462.Google Scholar
3. Jaquiss, RD, Siehr, SL, Ghanayem, NS, et al. Early cavopulmonary anastomosis after Norwood procedure results in excellent Fontan outcome. Ann Thorac Surg 2006; 82: 1260–1266.Google Scholar
4. Jaquiss, RD, Ghanayem, NS, Hoffman, GM, et al. Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 2004; 127: 982–989.Google Scholar
5. Ghanayem, NS, Tweddell, JS, Hoffman, GM, Mussatto, K, Jaquiss, RD. Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young 2006; 16: 61–66.Google Scholar
6. Slavik, Z, Lamb, RK, Webber, SA, et al. Bidirectional superior cavopulmonary anastomosis: how young is too young? Heart 1996; 75: 78–82.Google Scholar
7. Reddy, VM, McElhinney, DB, Moore, P, Haas, GS, Hanley, FL. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. J Am Coll Cardiol 1997; 29: 1365–1370.Google Scholar
8. Gérelli, S, Boulitrop, C, Van Steenberghe, M, et al. Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy? Eur J Cardiothorac Surg 2012; 42: 513–519.Google Scholar
9. Chen, Q, Tulloh, R, Caputo, M, Stoica, S, Kia, M, Parry, AJ. Does the persistence of pulsatile antegrade pulmonary blood flow following bidirectional Glenn procedure affect long term outcome? Eur J Cardiothorac Surg 2015; 47: 154–158.Google Scholar
10. Adachi, I, Yagihara, T, Kagisaki, K, et al. Preoperative small pulmonary artery did not affect the midterm results of Fontan operation. Eur J Cardiothorac Surg 2007; 32: 156–162.Google Scholar
11. Reddy, VM, McElhinney, DB, Moore, P, Petrossian, E, Hanley, FL. Pulmonary artery growth after bidirectional cavopulmonary shunt: is there a cause for concern? J Thorac Cardiovasc Surg 1996; 112: 1180–1192.Google Scholar
12. Ovroutski, S, Ewert, P, Alexi-Meskishvili, V, et al. Absence of pulmonary artery growth after Fontan operation and its possible impact on late outcome. Ann Thorac Surg 2009; 87: 826–832.Google Scholar
13. Iyengar, AJ, Winlaw, DS, Galati, JC, et al. The extracardiac conduit Fontan procedure in Australia and New Zealand: hypoplastic left heart syndrome predicts worse early and late outcomes. Eur J Cardiothorac Surg 2014; 46: 465–473.Google Scholar
14. Feinstein, JA, Benson, DW, Dubin, AM, et al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59 (Suppl): S1–42.Google Scholar
15. Meza, JM, Hickey, E, McCrindle, B, et al. The optimal timing of stage-2-palliation after the Norwood operation. Ann Thorac Surg 2018; 105: 193–199.Google Scholar
16. Nakano, T, Kado, H, Tatewaki, H, et al. Results of extracardiac conduit total cavopulmonary connection in 500 patients. Eur J Cardiothorac Surg 2015; 48: 625–632.Google Scholar