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Bidirectional cavopulmonary anastomosis in patients under two years of age
S B Albanese1, A Carotti, R M Di Donato
1Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Bambino Gesù, Rome, Italy.
Insights
This study evaluated the bidirectional cavopulmonary anastomosis in 27 young patients, finding heterotaxia syndrome and high pulmonary artery pressure as mortality risk factors. Overall mortality was 15% hospital deaths and 8.7% late deaths.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Bidirectional cavopulmonary anastomosis is a palliative surgical procedure for complex congenital heart defects.
- Early outcomes in very young children undergoing this procedure require careful evaluation.
Purpose of the Study:
- To assess the outcomes of bidirectional cavopulmonary anastomosis in patients younger than 2 years.
- To identify risk factors associated with mortality in this patient cohort.
Main Methods:
- A retrospective review of 27 patients under 2 years old who underwent bidirectional cavopulmonary anastomosis between 1986 and 1990.
- Analysis of patient demographics, diagnoses (pulmonary atresia/stenosis, heterotaxia syndrome), surgical details, and mortality rates.
Main Results:
- Hospital mortality was 15% (4/27), with two late deaths (8.7%) before further surgery.
- Heterotaxia syndrome and preoperative mean pulmonary artery pressure >15 mm Hg were identified as potential risk factors for overall mortality (p=0.087 and p=0.09, respectively).
- Two patients undergoing definitive repair after the anastomosis died, one with acquired pulmonary arteriovenous fistulas and another with valve regurgitation.
Conclusions:
- Bidirectional cavopulmonary anastomosis in young children has significant associated mortality.
- Heterotaxia syndrome and elevated pulmonary artery pressure may indicate a higher risk profile.
- Further investigation into risk stratification and management strategies is warranted.
Abstract:
Between December 1986 and December 1990, a bidirectional cavopulmonary anastomosis was performed in 27 patients younger than 2 years of age, including 12 with heterotaxia syndrome. Age and weight of patients averaged 14.2 +/- 6.6 months and 8.1 +/- 2.2 kg, respectively. Eleven had pulmonary atresia and 16 had pulmonary stenosis. The main pulmonary artery was ligated in seven patients in the latter group (subsequently reopened in one) and left open in nine (subsequently ligated in two). There were four hospital deaths (15%). All patients were discharged with anticoagulant/antithrombotic therapy to be continued for 6 months. There were two late deaths before further operations (8.7%). Two patients, one with acquired massive pulmonary arteriovenous fistulas and one with progressive common atrioventricular valve regurgitation, subsequently underwent definitive repair (biventricular in one), and both died. Heterotaxia syndrome (p = 0.087) and preoperative mean pulmonary artery pressure higher than 15 mm Hg (p = 0.09) were the only risk factors for overall mortality.