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Bidirectional superior cavopulmonary connection in young infants
S M Bradley1, R S Mosca, H A Hennein
1Department of Surgery, Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, USA.
Circulation
|November 1, 1996
Summary
Bidirectional superior cavopulmonary connection (BSCC) is safe for infants under six months. While younger infants face higher risks of pulmonary artery thrombosis and early hypoxemia, operative death rates remain low.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Surgical Outcomes Research
Background:
- Bidirectional superior cavopulmonary connection (BSCC) is a common palliative procedure for univentricular AV connections.
- Concerns exist regarding the safety and efficacy of BSCC in very young infants, particularly concerning perioperative outcomes and postoperative oxygenation.
- This study evaluates the outcomes of BSCC in infants younger than 6.5 months to determine the impact of young age on operative results and oxygenation.
Purpose of the Study:
- To assess the safety and effectiveness of BSCC in infants under 6.5 months of age.
- To investigate whether younger age influences operative outcomes, including mortality and morbidity.
- To evaluate the effect of young age on postoperative oxygenation and define the lower age limit for successful BSCC.
Main Methods:
- Retrospective review of 85 consecutive patients under 6.5 months old who underwent BSCC between December 1990 and February 1995.
- Analysis of patient age, operative outcomes (mortality, pulmonary artery thrombosis), and postoperative oxygenation (arterial PO2, oxygen saturation).
- Statistical evaluation to determine the association between younger age and adverse outcomes.
Main Results:
- Five hospital deaths (6%) occurred; younger age was not significantly associated with operative death.
- Pulmonary artery thrombosis occurred in 3 patients (4%); younger age was significantly associated with this complication.
- Oxygenation improved significantly within 48 hours post-BSCC, but younger age was linked to poorer early postoperative oxygenation.
Conclusions:
- BSCC can be successfully performed in infants as young as 5 weeks old.
- Younger age (< 6 months) is not a risk factor for perioperative death but is associated with increased risk of pulmonary artery thrombosis and early hypoxemia.
- BSCC can be considered beyond the neonatal period for symptomatic patients, or delayed until 4-6 months if elective.