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Pulmonary circulation evaluation before cavopulmonary connections: the cavopulmonary bypass
A Serraf1, L Houyel, F Nicolas
1Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France.
The Annals of Thoracic Surgery
|October 1, 1994
Summary
Accurate preoperative pulmonary vascular resistance (PVR) assessment is crucial for Fontan procedures. Intraoperative PVR measurements strongly correlate with early postoperative outcomes, unlike preoperative estimates.
Area of Science:
- Cardiology
- Pediatric Surgery
- Hemodynamics
Background:
- Pulmonary vascular resistances (PVRs) are critical risk factors influencing Fontan-type procedure outcomes.
- Preoperative PVR calculations can be inaccurate, especially in complex cases like pulmonary atresia.
Purpose of the Study:
- To develop a reliable method for assessing pulmonary vascular bed hemodynamics before Fontan procedures.
- To evaluate the correlation between intraoperative PVR measurements and early postoperative outcomes.
Main Methods:
- Simulated Fontan circulation using partial cardiopulmonary bypass (cavopulmonary bypass) in 13 patients.
- Recorded hemodynamic data, including pressures and resistances, during cavopulmonary bypass.
- Correlated intraoperative PVR measurements with early postoperative outcomes using a subjective scale.
Main Results:
- No significant correlation was found between preoperative and perioperative PVR index calculations.
- Strong positive correlations were observed between intraoperative PVR, indexed PVR, and the pulmonary to systemic vascular resistance ratio with early outcomes.
- No mortality or morbidity was associated with the intraoperative procedure.
Conclusions:
- Intraoperative PVR assessment provides a reliable predictor of early outcomes following Fontan-type procedures.
- Preoperative PVR estimations may not accurately reflect the hemodynamic status relevant to Fontan surgery outcomes.