Bidirectional cavopulmonary anastomosis in congenital heart disease. Functional and clinical outcome
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S Giannico1, G Santoro, B Marino
1Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesu' Hospital, Rome, Italy.
Insights
Bidirectional cavopulmonary anastomosis (BCPA) reduces ventricular volumes in children with congenital heart disease. However, BCPA is not a definitive palliation, showing impaired functional capacity in stress tests.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Hemodynamics
Background:
- Cyanotic congenital heart disease with univentricular physiology requires surgical palliation.
- Bidirectional cavopulmonary anastomosis (BCPA) increases pulmonary blood flow without increasing cardiac workload.
- BCPA can serve as a staged palliation or a definitive procedure for high-risk Fontan candidates.
Purpose of the Study:
- To evaluate the hypothesis that BCPA offers definitive palliation for select patients.
- To assess hemodynamic, clinical, and functional outcomes after BCPA.
- To compare pre- and post-operative data to determine the efficacy of BCPA as a standalone procedure.
Main Methods:
- Retrospective analysis of 74 patients undergoing BCPA.
- Evaluation of hemodynamic parameters, including end-diastolic and end-systolic ventricular volumes.
- Assessment of clinical and functional outcomes via ambulatory ECG, spirometry, echocardiography, and stress testing.
Main Results:
- BCPA significantly reduced end-diastolic and end-systolic ventricular volumes (p < 0.0005).
- Ambulatory ECG, spirometry, and echocardiography showed normal results post-BCPA.
- Stress tests revealed significantly impaired functional capacity, with reduced mean work time and peak heart rate.
Conclusions:
- BCPA is not an adequate definitive palliation for patients with univentricular physiology.
- BCPA effectively preserves pulmonary arteries and prepares the systemic ventricle for subsequent Fontan repair.
- The procedure is a valuable intermediate step in the staged surgical management of complex congenital heart disease.
Abstract:
The bidirectional cavopulmonary anastomosis is a surgical procedure suitable for patients with cyanotic congenital heart disease and univentricular physiology. This operation is able to increase the effective pulmonary blood flow without any additional load on the cardiac work and without any further distortion on the pulmonary artery branches. The cavopulmonary anastomosis can represent the first stage for patients destined for Fontan repair or a definitive palliative operation in high risk Fontan candidates. In order to test the hypothesis of a definitive palliation by cavopulmonary anastomosis in this kind of patients, we evaluated the hemodynamic data before and after this surgical approach and compared these data with their clinical and functional outcome. We evaluated 74 patients submitted to bidirectional cavopulmonary anastomosis by either hemodynamic or functional evaluation. End-diastolic and end-systolic ventricular volumes were significantly reduced by bidirectional cavopulmonary anastomosis (p less than 0.0005). Despite these data and a normal ambulatory ECG, spirometry and echocardiographic analysis, the stress test showed discouraging results. In fact, mean work time and peak heart rate were significantly different from normal values showing an impaired functional capacity of these children. In conclusion we think that bidirectional cavopulmonary anastomosis can not be considered an adequate definitive palliation but it represents a very good stage to preserve the pulmonary arteries and to prepare the systemic ventricle towards the Fontan repair.