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Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion

Published online by Cambridge University Press:  23 February 2015

Katrien François ,
Kristof Vandekerckhove ,
Katya De Groote ,
Joseph Panzer ,
Daniel De Wolf ,
Hans De Wilde  and
Thierry Bové
Katrien François*
Affiliation:
Department of Congenital Cardiac Surgery, The Cardiac Centre, University Hospital Gent, Belgium
Kristof Vandekerckhove
Affiliation:
Department of Pediatric Cardiology, The Cardiac Centre, University Hospital Gent, Belgium
Katya De Groote
Affiliation:
Department of Pediatric Cardiology, The Cardiac Centre, University Hospital Gent, Belgium
Joseph Panzer
Affiliation:
Department of Pediatric Cardiology, The Cardiac Centre, University Hospital Gent, Belgium
Daniel De Wolf
Affiliation:
Department of Pediatric Cardiology, The Cardiac Centre, University Hospital Gent, Belgium
Hans De Wilde
Affiliation:
Department of Pediatric Cardiology, The Cardiac Centre, University Hospital Gent, Belgium
Thierry Bové
Affiliation:
Department of Congenital Cardiac Surgery, The Cardiac Centre, University Hospital Gent, Belgium
*
Correspondence to: K. François, MD, Department of Cardiac Surgery, University Hospital Gent, De Pintelaan 185, 9000 Gent, Belgium. Tel: +0032 9 332 47 00; Fax: +0032 9 332 38 82; E-mail: [email protected]
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Abstract

Objectives

The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion.

Methods

A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary – mortality and survival to Fontan completion – and secondary outcome endpoints – re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1–3 interventions had preceded. Norwood-type procedures became more prevalent over time.

Results

Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion.

Conclusion

The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained.

Keywords

Congenital heart diseasesingle ventriclepaediatric cardiac surgerypost-operative management
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 2 , February 2016 , pp. 288 - 297
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Copyright
© Cambridge University Press 2015 

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