Bi-directional cavopulmonary shunt: is accessory pulsatile flow, good or bad?

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Cardiovascular Physiology

Background:

• Bi-directional cavopulmonary connection (BCPC) is a palliative surgical procedure for complex congenital heart defects.
• Accessory pulsatile blood flow is a potential outcome following BCPC, with varying mechanisms of maintenance.

Purpose of the Study:

• To evaluate the effect and long-term outcomes of accessory pulsatile blood flow compared to classical BCPC.
• To determine if accessory pulsatile flow impacts subsequent Fontan completion and overall survival.

Main Methods:

• Retrospective review of medical and surgical records for 205 patients who underwent BCPC between 1990 and 1996.
• Analysis of patient demographics, surgical variations, hospital and late mortality, pulmonary artery pressure, oxygen saturation, and time to Fontan completion.

Main Results:

• Accessory pulsatile flow was present in 68% of patients, with diverse mechanisms.
• Patients with accessory pulsatile flow showed lower hospital mortality (3% vs 5%) and significantly higher mean pulmonary artery pressure and oxygen saturation increase.
• Despite higher late mortality (6% vs 1%) in the accessory pulsatile flow group, late oxygen saturation was significantly higher (85% vs 79%), with earlier Fontan completion (1.7 vs 2.7 years).

Conclusions:

• The overall outcome of BCPC was not significantly different between accessory pulsatile flow and classical BCPC.
• Accessory pulsatile blood flow is not a contraindication for Fontan completion and is associated with improved late oxygen saturation and earlier Fontan procedure.
• Survival is not influenced by age at BCPC, ventricular anatomy, or prior palliative surgery.