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Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional
Christian Schreiber1, Julie Cleuziou, Juliane K Cornelsen
1Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Germany. schreiber@dhm.mhn.de
Insights
This study found that performing bidirectional cavopulmonary connection (BCPC) without additional blood flow leads to favorable hemodynamics and pulmonary artery growth. This supports early staging and swift completion to total cavopulmonary connection (TCPC).
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- Bidirectional cavopulmonary connection (BCPC) is a surgical step towards total cavopulmonary connection (TCPC).
- Institutional policies vary regarding residual blood flow after BCPC.
- The impact of zero residual blood flow on hemodynamics and pulmonary artery development is not well-established.
Purpose of the Study:
- To evaluate the hemodynamic and pulmonary artery developmental effects of performing BCPC without any additional blood flow.
- To assess the safety and efficacy of this specific surgical strategy.
Main Methods:
- A retrospective review of 124 patients who underwent completion to TCPC between 2001 and 2006.
- Analysis of 84 pre-BCPC and pre-TCPC angiograms to measure pulmonary artery dimensions.
- Hemodynamic parameters including oxygen saturation, PA pressures, and blood flow ratios were analyzed.
Main Results:
- No postoperative mortality after BCPC; 1.2% mortality after TCPC.
- Mean oxygen saturation increased post-BCPC (74.4% to 79.6%).
- Pulmonary artery pressures and left atrial pressure showed favorable trends.
- Pulmonary/systemic blood flow and resistance ratios significantly decreased post-BCPC.
- Significant increase in right and right lower lobe pulmonary artery diameters observed post-BCPC.
Conclusions:
- Performing BCPC without additional blood flow results in favorable hemodynamic conditions for subsequent TCPC.
- This strategy supports early BCPC staging and timely completion to TCPC.
- The findings validate the institution's policy of zero residual blood flow after BCPC.
Objective:
Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional cavopulmonary connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development.
Methods:
Between 2001 and 2006 a total of 124 patients had completion to a total cavopulmonary connection (TCPC). Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA).
Results:
Mean age at BCPC was 12.6+/-15.3 months. Mean age at time of TCPC was 31.3+/-18.7 months, with an interval of 18.6+/-11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p<0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9mmHg prior to TCPC (p=0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p=0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p<0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p<0.01). The left PA also increased in size, although this was not statistically significant.
Conclusions:
After BCPC without additional blood flow, hemodynamic findings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.
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