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Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old
V M Reddy1, D B McElhinney, P Moore
1Division of Cardiothoracic Surgery, University of California San Francisco 94143-0118, USA.
Insights
Bidirectional cavopulmonary shunt (BCPS) outcomes in infants under six months are comparable to older children. However, delaying BCPS until after two months of age is preferred to improve results.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Cardiovascular Surgery
Background:
- Bidirectional cavopulmonary shunt (BCPS) is a standard palliative procedure for single-ventricle heart defects.
- Limited data exists on BCPS outcomes in infants younger than six months.
Purpose of the Study:
- To evaluate the results of BCPS in infants under six months of age.
- To identify risk factors associated with poor outcomes after BCPS in this population.
Main Methods:
- Retrospective review of 42 infants (< 6 months) undergoing BCPS between 1990 and present.
- Data collected on preoperative, perioperative factors, and follow-up outcomes.
- Analysis of risk factors for mortality and shunt failure.
Main Results:
- Overall hospital mortality was 4.8%.
- 17% of patients required reoperation for BCPS or pulmonary blood flow issues.
- Age under two months was a significant risk factor for early death and BCPS failure.
Conclusions:
- Outcomes after BCPS in young infants are similar to older patients.
- A preference for deferring BCPS until after two months of age is recommended to improve outcomes.
Objectives:
We sought to assess the results after bidirectional cavopulmonary shunt (BCPS) in infants < 6 months old and to identify risk factors for poor outcome.
Background:
Although BCPS is a well established procedure for the palliation of patients with a single-ventricle heart, there have been very few reports of outcomes after BCPS in young infants.
Methods:
Since 1990, 42 infants between 0.8 and 6.0 months of age (mean [+/-SD] 3.7 +/- 1.4) have undergone BCPS for primary (n = 16) or secondary (n = 26) palliation of tricuspid atresia (n = 13), hypoplastic left heart syndrome (n = 10) or other forms of functional single-ventricle heart (n = 19). Accessory pulmonary blood flow was included in 18 patients. Preoperative and perioperative data were gathered on retrospective review of patient records, and follow-up was conducted by means of direct physician contact or record review.
Results:
The overall hospital mortality rate, including that associated with reoperations, was 4.8% (2 of 42 patients). Seven patients (17%) required reoperation related to the BCPS or pulmonary blood flow in the early postoperative period: Procedures included take-down of the BCPS in four patients, with one early death, and procedures to decrease pulmonary blood flow in three patients. Age < 1 month correlated significantly with early death and with early failure of the BCPS (death or take-down). Follow-up of the 37 patients discharged with intact BCPS was obtained at a mean +/-SD of 14.3 +/- 11.3 months postoperatively, during which time three patients died (at 6.5 +/- 2.5 months). The 2-year actuarial survival rate for patients undergoing BCPS at < 6 months of age was 86%. Overall freedom from death or take-down (including early and late events) was significantly lower in patients < 2 months old than in those > 2 months old. Four patients have undergone successful Fontan completion (18.3 +/- 2.9 months postoperatively), and one patient whose BCPS was taken down subsequently underwent successful restoration of a BCPS.
Conclusions:
Outcomes after BCPS in young infants are comparable to those in older infants and children. However, our current preference is to defer this procedure until after 2 months of age.