The clinical impact of percutaneous balloon expandable endovascular stents in the management of early postoperative vascular obstruction

AbstractTo assess the clinical impact of percutaneously implanted balloon expandable endovascular stents on patient management, we reviewed 20 children aged 14 days to 4.8 years (median 1.3 years) with residual vascular obstructions in the immediate postoperative period. Patients included 11 with pulmonary arterial stenosis, five with stenosis of venous pathways after a modified Fontan procedure or bidirectional cavopulmonary anastomosis, and four with a restrictive modified Blalock-Taussig shunt. Placement of the stent was optimal in 18 of 20 patients (24 of 26 Palmaz or Palmaz-Schatz implants). In two patients, rupture of the balloon resulted in malposition of the stent. Reoperation was avoided and symptomatic improvement was noted in 11 of 20 patients (55%), while procedural complications occurred in eight patients. Seven of 10 patients presenting with a low cardiac output syndrome died despite relief of the obstructions. This early experience supports consideration of the application of these devices in the management of significant vascular obstructive lesions in the immediate postoperative period, thus avoiding early reoperation in this profoundly compromised population.

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the clinical impact of antegrade pulmonary blood flow on the bidirectional cavopulmonary shunt in infants

Cardiology in the Young ◽

10.1017/s1047951104006559 ◽

2004 ◽

Vol 14 (S3) ◽

pp. 44-47 ◽

Cited By ~ 5

Author(s):

lucia migliazza ◽

francesco seddio ◽

francesco paolo annecchino ◽

giancarlo crupi

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Ventricular Dysfunction ◽

Fontan Procedure ◽

Volume Overload ◽

Clinical Impact ◽

Cavopulmonary Anastomosis ◽

Alternative Sources ◽

Bidirectional Cavopulmonary Anastomosis ◽

Cavopulmonary Shunt

the bidirectional cavopulmonary anastomosis is commonly used in the palliation of patients with a functionally univentricular physiology. the management of alternative sources of flow of blood to the lungs, as well as the magnitude of acceptable accessory blood flow at the time of surgery, nonetheless, remains controversial. these issues are particularly significant when a cavopulmonary anastomosis is performed in infants who may become candidates for a fontan procedure. indeed, a long-standing volume overload, which is invariably associated with the maintenance of accessory sources of pulmonary blood flow, may result in systemic ventricular dysfunction. these observations prompted us to review the influence of antegrade pulmonary blood flow in the management of infants undergoing a cavopulmonary anastomosis.

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Clinical Impact of Autologous Cell Therapy on Hypoplastic Left Heart Syndrome After Bidirectional Cavopulmonary Anastomosis

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.11.002 ◽

2020 ◽

Author(s):

Marie Vincenti ◽

Patrick W. O'Leary ◽

M. Yasir Qureshi ◽

Drew K. Seisler ◽

Harold M. Burkhart ◽

...

Keyword(s):

Cell Therapy ◽

Hypoplastic Left Heart Syndrome ◽

Clinical Impact ◽

Left Heart ◽

Hypoplastic Left Heart ◽

Autologous Cell ◽

Cavopulmonary Anastomosis ◽

Autologous Cell Therapy ◽

Bidirectional Cavopulmonary Anastomosis ◽

Left Heart Syndrome

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Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117728505 ◽

2017 ◽

Vol 8 (5) ◽

pp. 575-583 ◽

Cited By ~ 2

Author(s):

Nataliya R. Nichay ◽

Yuriy N. Gorbatykh ◽

Igor A. Kornilov ◽

Ilya A. Soynov ◽

Yuriy Y. Kulyabin ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards ◽

Cox Regression ◽

Fontan Procedure ◽

Unfavorable Outcome ◽

Atrioventricular Valve Regurgitation ◽

Cavopulmonary Anastomosis ◽

Mean Pressure ◽

Bidirectional Cavopulmonary Anastomosis ◽

Anomalous Pulmonary Venous Connection

Background: Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA. Methods: Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed. Results: Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression. Conclusions: Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.

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Causes of complicated course of patients in the near future postoperative period, undergoing Fontaine's surgery in the modification of the extracardiac conduit after a previously performed bidirectional cavopulmonary anastomosis

Clinical Physiology of Circulation ◽

10.24022/1814-6910-2018-15-3-169-177 ◽

2018 ◽

Vol 15 (3) ◽

pp. 169-177

Author(s):

E.S. Nikitin ◽

I.A. Yurlov ◽

D.V. Kovalev ◽

M.A. Murzov ◽

I.M. Makrushin

Keyword(s):

Postoperative Period ◽

Extracardiac Conduit ◽

Cavopulmonary Anastomosis ◽

Complicated Course ◽

Bidirectional Cavopulmonary Anastomosis ◽

Near Future

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Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

Cardiology in the Young ◽

10.1017/s1047951112001175 ◽

2012 ◽

Vol 23 (3) ◽

pp. 335-343 ◽

Cited By ~ 9

Author(s):

Andrew M. Atz ◽

Thomas G. Travison ◽

Brian W. McCrindle ◽

Lynn Mahony ◽

Andrew C. Glatz ◽

...

Keyword(s):

Fontan Procedure ◽

Cross Sectional Study ◽

Univentricular Heart ◽

P Value ◽

Cross Sectional ◽

Ventricular Performance ◽

Cavopulmonary Anastomosis ◽

Bidirectional Cavopulmonary Anastomosis ◽

Fontan Surgery ◽

Cavopulmonary Connection

AbstractBackgroundA superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.MethodsWe compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).ResultsA prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.ConclusionsAfter controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.

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the effect of the position of an additional systemic-to-pulmonary shunt on the fluid dynamics of the bidirectional cavo-pulmonary anastomosis

Cardiology in the Young ◽

10.1017/s1047951104006547 ◽

2004 ◽

Vol 14 (S3) ◽

pp. 38-43 ◽

Cited By ~ 4

Author(s):

francesca gervaso ◽

silvia kull ◽

giancarlo pennati ◽

francesco migliavacca ◽

gabriele dubini ◽

...

Keyword(s):

Pulmonary Stenosis ◽

Fontan Procedure ◽

Pulmonary Arteries ◽

Volume Overload ◽

Additional Source ◽

Arteriovenous Fistulas ◽

Palliative Procedure ◽

Cavopulmonary Anastomosis ◽

One Step ◽

Bidirectional Cavopulmonary Anastomosis

the bidirectional cavo-pulmonary anastomosis is a well-established palliative procedure for patients with a functionally univentricular circulation. it is usually considered one step in preparation for fontan procedure, but it may be performed as a long-term palliation for patients deemed to be at high-risk. in this subset of patients, a valuable surgical option could be to add, or maintain, an additional source of flow of blood to the lungs, either derived from a patent but banded trunk or one protected by native pulmonary stenosis, or a systemic-to-pulmonary arterial shunt. the risk and benefits of providing an additional source of pulmonary flow after construction of a bidirectional cavopulmonary anastomosis are strongly debated. in terms of benefit, the arterial saturation of oxygen is increased due to the greater ratio of pulmonary-to-systemic flow, arteriovenous fistulas are prevented and, as a consequence of the arterial pulsatile flow, the pulmonary arteries are stimulated to grow. the most significant drawbacks are volume overload of the functionally single ventricle, and higher pressures compared to an isolated bidirectional cavopulmonary anastomosis.

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