Thorac Cardiovasc Surg 2013; 61 - P12
DOI: 10.1055/s-0033-1354501

Early Bidirectional Cavopulmonary Anastomosis: Impact on ICU Therapy, Oxygenation, and Outcome

B Ruf 1, G Balling 1, A Eicken 1, J Kasnar-Samprec 2, J Cleuziou 2, I Malcic 3, P Ewert 1
  • 1Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Technische Universität, Germany
  • 2Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum München, Technische Universität, Germany
  • 3Department of Pediatric Cardiology, University Hospital Rebro, Zagreb, Croatia

Objectives: The interstage mortality before bidirectional cavopulmonary anastomosis (BCPA) is the highest on the way to Fontan completion. In case of aortopulmonary shunt palliation BCPA seems to improve hemodynamic conditions, but an increased pulmonary resistance in younger infants has an impact on oxygenation. The aim of this study was to evaluate both early and late mortality and ICU course relative to younger age at BCPA.

Methods: Retrospective analysis of patient records and imaging files from patients who underwent BCPA between January 2006 and April 2013. Based on age at BCA two groups were formed. BPCA was performed at age ≤90 days in group I and > 90 days in group II.

Results: In total 205 patients underwent a BCPA, n= 31 in group I and n= 174 in group II. Total 42% of the patients had a hypoplastic left heart syndrom. There were no significant differences in early (n= 0 in group I vs. n= 6 in group II, p= 0.59) and late mortality (n= 1 in group I vs. n= 18 in group II, p= 0.32) or survival to total cavopulmonary connection. The time on respirator was significant longer in group I (median 21h vs. 13h, p= 0.006), but the incidence of severe postoperative complications (severe cyanosis with need of ECMO or reintervention, prolonged pleural effusions, etc.) in group I was not higher than in group II.

Conclusion: An early BCPA to improve hemodynamic conditions seems to be feasible without higher mortality or severe postoperative complications and reasonable time on respirator.