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Outcomes after bidirectional cavopulmonary shunt with antegrade pulmonary blood flow in high-risk patients

Lea Behrend1,2,3, Thibault Schaeffer1,2,3, Takuya Osawa1,2,3

  • 1Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.

Cardiology in the Young
|September 18, 2024
PubMed

Insights

Antegrade pulmonary blood flow (APBF) was used in 8% of high-risk patients undergoing bidirectional cavopulmonary shunt (BCPS). While hospital stay and mortality were higher, long-term survival was similar for patients with and without APBF.

Area of Science:

  • Congenital Heart Surgery
  • Pediatric Cardiology
  • Cardiovascular Surgery

Background:

  • Bidirectional cavopulmonary shunt (BCPS) is a staged surgical palliation for complex congenital heart disease.
  • Antegrade pulmonary blood flow (APBF) is sometimes maintained during BCPS in high-risk patients.
  • Indications and outcomes of APBF in BCPS require further evaluation.

Purpose of the Study:

  • To evaluate the indications for maintaining antegrade pulmonary blood flow (APBF) during bidirectional cavopulmonary shunt (BCPS).
  • To compare the outcomes of patients with and without APBF after BCPS.

Main Methods:

  • Retrospective review of patients who underwent BCPS between 1997 and 2022.
  • Identification of patients with and without APBF post-BCPS.
  • Comparison of demographic data, indications for APBF, hospital course, and long-term survival.

Main Results:

  • APBF was utilized in 8.2% of 461 patients, primarily for high pulmonary artery pressure, hypoxemia, or hypoplastic pulmonary arteries.
  • Patients with APBF had longer hospital stays and higher in-hospital mortality.
  • Hospital survivors with and without APBF demonstrated similar long-term survival after BCPS and subsequent total cavopulmonary connection (TCPC).

Conclusions:

  • APBF is employed in a small subset of high-risk BCPS patients, often due to elevated preoperative pulmonary artery pressure.
  • Despite increased initial morbidity, APBF does not appear to compromise long-term survival for hospital survivors.
  • Maintaining APBF during BCPS may be a viable strategy for select high-risk pediatric cardiac surgery patients.
Abstract

Keywords:
Single ventricleantegrade pulmonary blood flowbidirectional cavopulmonary shuntpulmonary artery pressuretotal cavopulmonary connection

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