Related Experiment Video
Updated: Jul 6, 2026
A Preclinical Model of Orthotopic Heart Transplantation in Bama Miniature Pigs Using Biatrial Technique
Published on: June 13, 2025
Results with continuous cardiopulmonary bypass for the bidirectional cavopulmonary anastomosis
Robroy H MacIver1, Robert D Stewart, Carl L Backer
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America.
Insights
This study shows that continuous cardiopulmonary bypass with moderate hypothermia is a successful method for bidirectional cavopulmonary anastomosis. This technique avoids circulatory arrest and is not associated with late anastomotic stenosis.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Repair
- Cardiovascular Surgery Techniques
Background:
- The bidirectional cavopulmonary anastomosis is a crucial step in creating the Fontan circulation for complex congenital heart defects.
- Surgical techniques for this procedure vary, with ongoing debate regarding the optimal use of cardiopulmonary bypass and hypothermia.
- Continuous cardiopulmonary bypass with moderate hypothermia is a widely adopted method, but its outcomes require thorough evaluation.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous cardiopulmonary bypass with moderate hypothermia for bidirectional cavopulmonary anastomosis.
- To compare outcomes with alternative techniques like deep hypothermic circulatory arrest.
- To assess the incidence of anastomotic complications and long-term patency.
Main Methods:
- A retrospective review of 114 patients undergoing bidirectional cavopulmonary anastomosis between 1990 and 2005.
- All patients received continuous cardiopulmonary bypass with moderate hypothermia (32°C).
- Interrupted absorbable sutures were used for anastomosis in most cases; some patients also underwent simultaneous intracardiac procedures with aortic cross-clamping.
Main Results:
- The perioperative mortality rate was 5%.
- The mean cardiopulmonary bypass time for isolated anastomosis was 91 minutes.
- No stenoses were observed on postoperative angiograms in 76 patients, and the use of absorbable sutures was not linked to late stenosis.
Conclusions:
- Continuous cardiopulmonary bypass with moderate hypothermia is a safe and effective method for bidirectional cavopulmonary anastomosis.
- This technique allows the procedure to be performed with a beating heart, avoiding the need for circulatory arrest.
- The use of interrupted absorbable sutures is associated with favorable long-term anastomotic patency.
Objective:
Some centres have proposed creating the bidirectional cavopulmonary anastomosis without cardiopulmonary bypass, while others continue to use deep hypothermic circulatory arrest. The purpose of this review is to evaluate the results of using continuous cardiopulmonary bypass with moderate hypothermia, perhaps the most commonly used of the three techniques for this procedure.
Methods:
Between 1990 and 2005, 114 patients, having a mean age of 1.58 years, with a median age of 8 months, and ranging from 3 months to 16 years, underwent creation of either a unilateral cavopulmonary anastomosis, in 94 cases, or bilateral anastomoses in 20 cases. All had continuous cardiopulmonary bypass with moderate hypothermia at 32 degrees Celsius, with 24 also having aortic cross-clamping with cardioplegia for simultaneous intracardiac procedures. Interrupted absorbable sutures were used to create the anastomosis in 105 patients.
Results:
Perioperative mortality was 5%, with 6 of the patients dying. The mean period of cardiopulmonary bypass for an isolated anastomosis was 91 minutes, with a range from 44 to 160 minutes. In 10 patients (8.8%), it was necessary to place a graft to augment the anastomosis. The average postoperative length of stay was 7.9 days for those undergoing an isolated unilateral anastomosis, and 16.4 days for patients undergoing combined cardiac operations. We have now created the Fontan circulation in 79 of the patients, at an average interval from the bidirectional cavopulmonary anastomosis of 2.1 plus or minus 1.14 years. In 76 patients, we performed postoperative angiograms, and none revealed any stenoses.
Conclusions:
The bidirectional cavopulmonary anastomosis can be performed successfully with continuous cardiopulmonary bypass and moderate hypothermia with a beating heart, avoiding circulatory arrest. The use of interrupted and absorbable sutures was not associated with any late anastomotic stenosis.
