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The Outcomes of Superior Cavopulmonary Connection Operation: a Single Center Experience
Alwaleed Al-Dairy1, Maziar Gholampour Dehaki1, Gholamreza Omrani1
1Department of Cardiovascular Surgery, Division of Congenital Cardiac Surgery of Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
The superior cavopulmonary connection (SCPC) surgery has low mortality. However, high pulmonary artery pressure and prior pulmonary artery banding negatively impact outcomes for single-ventricle patients progressing to the Fontan operation.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
Background:
- The superior cavopulmonary connection (SCPC) is a critical palliative stage for single-ventricle physiology.
- Successful SCPC prepares patients for the Fontan operation, the final palliative step.
Purpose of the Study:
- To evaluate the outcomes of SCPC operations at our institution.
- To identify predictors of survival and progression to the Fontan stage after SCPC.
Main Methods:
- Retrospective analysis of 161 patients who underwent SCPC between 2005 and 2015.
- Statistical analysis to determine risk factors for mortality, takedown, and Fontan exclusion.
Main Results:
- Early mortality was 2.5%, with 3.1% requiring takedown and 8.3% excluded from Fontan.
- Elevated preoperative mean pulmonary artery pressure and prior pulmonary artery banding were significant risk factors for adverse outcomes.
- Patient age, single ventricle morphology, and surgical approach were not identified as risk factors.
Conclusions:
- SCPC can be performed with acceptable early mortality and morbidity.
- Preoperative pulmonary artery pressure and prior pulmonary artery banding are crucial factors associated with poorer outcomes, necessitating careful patient selection and management.
Introduction:
The superior cavopulmonary connection operation is one of the stages of the palliative surgical management for patients with functionally single ventricle. After surviving this stage, the patients are potential candidates for the final palliative procedure: the Fontan operation.
Objectives:
This study aimed to analyze the outcomes of superior cavopulmonary connection operations in our center and to identify factors affecting the survival and the progression to Fontan stage.
Methods:
The outcomes of 161 patients were retrospectively analyzed after undergoing superior cavopulmonary connection operation in our center between 2005 and 2015.
Results:
The early mortality rate was 2.5%. Five (3.1%) patients underwent takedown of the superior cavopulmonary connection. The rate of exclusion from the Fontan stage was 8.3%. Statistical analysis revealed that elevated mean pulmonary artery pressure preoperatively and the prior palliation with pulmonary artery banding were risk factors for both early mortality and takedown; however, the age, the morphology of the single ventricle and the type of operation were not considered risk factors.
Conclusion:
The superior cavopulmonary connection operation can be performed with low rate mortality and morbidity; however, the elevated mean pulmonary artery pressure preoperatively and the prior pulmonary artery banding are associated with poor outcomes.
