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Updated: Aug 14, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Mid-term results after bidirectional cavopulmonary shunts
J A Hawkins1, R E Shaddy, R W Day
1Department of Surgery, Primary Children's Medical Center, Salt Lake City, Utah.
Insights
The bidirectional cavopulmonary shunt offers excellent midterm survival and serves as a valuable staging procedure for high-risk single ventricle patients, facilitating later Fontan conversion in many cases.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Physiology
Background:
- Increasing use of bidirectional cavopulmonary shunt (BCPS) for single ventricle physiology.
- Limited data on long-term outcomes and Fontan conversion rates after BCPS.
Purpose of the Study:
- To evaluate the late results, palliation duration, and Fontan conversion success after BCPS.
- To assess survival and reoperation rates in high-risk pediatric patients undergoing BCPS.
Main Methods:
- Retrospective review of 38 children (4 months to 16 years) with single ventricle physiology undergoing BCPS (1984-1992).
- Analysis of pre- and post-operative oxygen saturation, survival data, and subsequent procedures.
- Assessment of conversion to Fontan or fenestrated Fontan procedures.
Main Results:
- Improved oxygen saturation from 75% to 82% (p < 0.05) at 24 months post-BCPS.
- Actuarial survival of 86% at 1 year and 81% at 6 years.
- Successful Fontan conversion in 58% (21/36) of survivors, with low operative mortality (4.8%).
Conclusions:
- BCPS demonstrates excellent midterm survival and effective palliation for high-risk single ventricle patients.
- BCPS serves as a suitable staging procedure, enabling successful Fontan conversion in a significant proportion of patients.
Abstract:
Despite the increasing use of the bidirectional cavopulmonary shunt, little is known about the late results, the duration of palliation, and the frequency with which this procedure allows later successful conversion to a Fontan type of procedure. We reviewed our experience (1984 to 1992) in 38 consecutive children, ages 4 months to 16 years (mean, 4.0 years), who underwent a bidirectional cavopulmonary shunt procedure. All had a single functional ventricle and represented high risks for the performance of a Fontan procedure based on anatomic and hemodynamic criteria. The oxygen saturation in these patients improved from a preoperative value of 75% +/- 7% to 82% +/- 7% (p < 0.05) at late cardiac catheterization by a mean of 24 months after operation. The actuarial survival, including early deaths and that associated with all secondary procedures, was 86% at 1 year and 81% at 6 years. Early deaths occurred in 5.3% (2/38) and late deaths in 11% (4/36). Late follow-up ranged from 5 to 90 months (mean, 37 months). Conversion to a Fontan or fenestrated Fontan procedure was accomplished in 21 early survivors (21/36; 58%) by a mean of 26 months after the bidirectional cavopulmonary shunt procedure, with one operative and no late deaths (1/21; 4.8%). Three additional patients have undergone late reoperation, including 2 requiring cardiac transplantation and 1 undergoing the late creation of an axillary artery-to-vein fistula for the treatment of cyanosis. The midterm survival after a bidirectional cavopulmonary shunt procedure appears to be excellent, and it serves as a good staging procedure for patients who represent high risks for a Fontan procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
