Takedown of cavopulmonary shunt at biventricular repair

With advances in valve repair and ventricular recruitment strategies, patients initially palliated with single ventricle physiology have been increasingly brought to biventricular circulation. Few data are available on the technical aspects and outcomes after takedown of the superior cavopulmonary anastomosis (bidirectional Glenn [BDG]). We reviewed a single-institutional experience in BDG takedown.

The demographic, procedural, and outcome data were obtained for all children who had undergone BDG takedown at our institution from 2000 to 2012. The primary outcome measures were achievement of biventricular circulation, reoperation, and mortality. The secondary outcome measures were postoperative arrhythmias, superior vena cava (SVC)-right atrium (RA) or pulmonary artery stenosis at the BDG takedown site.

A total of 40 patients were included during the study period, with a mean age of 4.4 years (range, 7 months to 22 years). Primary SVC-RA anastomosis was performed in 7 patients (18%), and an anterior patch was used in 33 patients (82%). Of the 40 patients, 38 were discharged with biventricular physiology (98%) and mild or less ventricular dysfunction. During a mean follow-up period of 3.4±2.9 years, 3 patients died and 1 required heart transplantation; 2 patients developed more than mild SVC stenosis requiring reintervention and 1 developed pulmonary artery stenosis. Finally, 34 patients were in normal sinus rhythm and 4 had heart block (1 pacemaker placement).

BDG takedown can be undertaken with a low operative risk and a low incidence of SVC or pulmonary artery stenosis or sinus node dysfunction. Additional follow-up is required to see how the reconstructed SVC grows.