Related Experiment Videos
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.
Insights
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.
Background:
Bidirectional superior cavopulmonary connection (BSCC) has become widely used in patients with univentricular AV connections. However, concerns remain about perioperative morbidity and mortality and about the adequacy of oxygenation after cavopulmonary connection in very young patients. This report examines our experience with BSCC in young infants to evaluate whether young age affects operative outcome, to examine the effect of young age on postoperative oxygenation, and to define the lower age limit for successful use of the procedure.
Methods And Results:
The records of the 85 consecutive patients < 6.5 months old who underwent BSCC from December 1990 through February 1995 were reviewed. The average patient age was 4.8 +/- 1.4 months (range, 5 weeks to 6.5 months), with 13 patients being < 3 months old. There were 5 hospital deaths (6%; 70% confidence limits, 3% to 10%). Pulmonary artery thrombosis occurred in 3 patients (4%; 70% confidence limits, 2% to 7%). Younger age was significantly associated with pulmonary artery thrombosis but not with operative death. Oxygenation (arterial PO2, and oxygen saturation) improved significantly and spontaneously over the first 48 hours after BSCC. Younger age had a significant adverse effect on oxygenation in the early postoperative period (first 48 hours).
Conclusions:
BSCC can be performed successfully in infants < 6 months old and as young as 5 weeks old. Within this patient population, younger age is not associated with perioperative death but is associated with pulmonary artery thrombosis and postoperative hypoxemia. We suggest that BSCC may be performed any time beyond the neonatal period in symptomatic patients and may be delayed until 4 to 6 months of age if completely elective.