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Institutional Experience of Assisting Cavopulmonary Circulation With Central Systemic Artery-to-Central Systemic Vein
Palleti Rajashekar1, Sachin Talwar2, Shyam Sunder Kothari1
1Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
A common carotid artery-to-internal jugular vein (CCA-IJV) shunt improved oxygen saturation in patients unsuitable for Fontan completion after superior cavopulmonary anastomosis. This procedure offers a viable option for selected complex congenital heart cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Patients with hypoxemia after bidirectional superior cavopulmonary anastomosis (BSCPA) and anatomy unsuitable for Fontan completion represent a challenging clinical group.
- Optimizing oxygenation and ventricular function in these complex cases is critical for improved outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of a common carotid artery-to-internal jugular vein (CCA-IJV) shunt in patients with hypoxemia and anatomy unsuitable for Fontan completion following BSCPA.
- To assess the impact of the CCA-IJV shunt on arterial oxygen saturation and clinical status.
Main Methods:
- A retrospective analysis of eight patients who underwent a CCA-IJV shunt between January 2010 and January 2015.
- Evaluation of pre- and post-procedure hemodynamic and clinical parameters, including arterial saturation, Pao2, and hematocrit.
Main Results:
- No early deaths were observed. Median arterial saturation increased from 67% to 83% post-procedure.
- Preoperative Pao2 improved, and hematocrit levels decreased significantly. Patients were New York Heart Association class II at median 24-month follow-up.
- Median intensive care unit and hospital stays were 2.5 and 7 days, respectively.
Conclusions:
- The CCA-IJV shunt is a potentially beneficial intervention for selected patients with complex congenital heart disease who are not candidates for Fontan completion after BSCPA.
- This procedure can effectively improve systemic oxygenation and may contribute to improved ventricular function in this high-risk population.
Objective:
Patients who have undergone a previous bidirectional superior cavopulmonary anastomosis and have hypoxemia and anatomy considered unsuitable for the Fontan completion present a difficult subset. We performed common carotid artery-to-internal jugular vein (CCA-IJV) shunt in these patients.
Methods:
Between January 2010 and January 2015, eight patients underwent a CCA-IJV shunt. Their records were analyzed retrospectively.
Results:
There were no early deaths. The baseline arterial saturation prior to the shunt procedure was median 67% (range 60%-72%), which increased to median 83% (range 80%-90%) after the procedure. The preoperative arterial oxygen partial pressure (Pao 2) ranged from 30 to 49 mm Hg (median 40 mm Hg). The hematocrit dropped from a preoperative median of 65% (range 55%-72%) to a median of 45% (range 42%-48%) after the procedure. Median intensive care unit stay was 2.5 days, and the median hospital stay was 7 days. Median follow-up was 24 months. At the last follow-up, these patients were classified in New York Heart Association class II.
Conclusions:
In a selected group of patients who are considered to be unsuitable for completion of Fontan circulation following superior cavopulmonary anastomosis, creation of a CCA-IJV shunt may be helpful to improve saturations and improve ventricular function.
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