Factors influencing arterial oxygenation early after bidirectional cavopulmonary shunt without additional sources of pulmonary blood flow

AbstractBackgroundThe bidirectional cavopulmonary shunt has become a mainstay in the palliation of patients with a functionally single ventricle. Despite its usefulness, there are a number of concerns following its construction, including issues of timing, the development of pulmonary arteriovenous fistulas, and growth of the pulmonary arteries.MethodsBetween January 1990 and April 1996, we constructed a bidirectional cavopulmonary shunt in 123 patients. Median age at surgery was 9.4 months, and ranged from 24 days to 43 years. In 25 patients (20%), it was the first operative procedure. An auxiliary source of pulmonary blood flow was included in 72 patients (58%).ResultsSix patients (4.9%) died in the early postoperative period, and the overall early rate of failure (death or take-down) was 8.1%(n=10). By multivariate analysis, longer bypass time (p=0.012), age less than 1 month (p=0.03), and higher pulmonary vascular resistance (p = 0.043) were significant. Early reoperation was performed in 11 other patients to decrease (n=8) or increase (n=3) the amount of pulmonary blood flow. Early survivors were followed for a median of 15 months (range: 1 to 48 months), during which time 5 patients died and a Fontan circulation was completed in 30. Including early and late mortality, actuarial survival rates at 1 and 2 years were 91% and 88%, respectively. Among hospital survivors, the only significant predictor of poorer survival by Cox regression was age less than 2 months at the time of the initial cavopulmonary shunt (p=0.02). Atrioventricular valvar regurgitation was decreased after construction of the cavopulmonary shunt in 17 of the 28 patients (61%) in whom echocardiographic data were available to compare preoperative and postoperative status.ConclusionsThe bidirectional cavopulmonary shunt is a useful procedure in the early or intermediate term management of patients with a functionally univentricular heart. Much remains to be learned, nonetheless, about this unique physiologic system. The role of accessory pulmonary blood flow remains unclear, as does the use of the shunt as long-term palliation. Pulmonary arteriovenous fistulas are a serious concern, especially in young patients with heterotaxy syndrome (isomeric atrial appendages).

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Long-term Results of Additional Pulmonary Blood Flow With Bidirectional Cavopulmonary Shunt

10.21203/rs.3.rs-31559/v1 ◽

2020 ◽

Author(s):

Ryosuke Kowatari ◽

Yasuyuki Suzuki ◽

Kazuyuki Daitoku ◽

Ikuo Fukuda

Keyword(s):

Blood Flow ◽

Liver Fibrosis ◽

Liver Function ◽

Pulmonary Blood Flow ◽

Fontan Procedure ◽

Bidirectional Cavopulmonary Shunt ◽

Pulmonary Arterial ◽

Cavopulmonary Shunt

Abstract Objective: We evaluatedadditional pulmonary blood flowat the time of bidirectional cavopulmonary shunt andits effectson the Fontan procedure andlong-term outcome of Fontan circulation and liver function.Methods: We included 22patients (16 boys, 6 girls) having undergonebidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean ageand body weight were 20 ±13 monthsand 7.5 ± 6.5 kg, respectively.We retrospectively evaluated the patients'clinical data,including cardiac catheterization data, liver function, and liver fibrosis markers.Results: All patients werealive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following:the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p<0.001);systemic ventricle end-diastolic pressure decreased from 11.4±3.2 mmHg to 6.9±3.6mmHg(p<0.001);and the pulmonary artery index decreased from 485.1±272.3 to 269.5 ± 100.5(p=0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure.Conclusions:The additional pulmonary blood flowat the time of bidirectional cavopulmonary shuntmaycontributeto pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistanceand without ventricle volumeoverload. The Fontan circulation was well-maintained at thelong-term follow-up, while liver fibrosis markerswere above their normal values.

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Bidirectional Cavopulmonary Shunt with Accessory Pulmonary Blood Flow

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230100900407 ◽

2001 ◽

Vol 9 (4) ◽

pp. 279-281 ◽

Cited By ~ 4

Author(s):

Pankaj Goel ◽

Kona Samba Murthy ◽

Kotturathu Mammen Cherian

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Bidirectional Cavopulmonary Shunt ◽

Cavopulmonary Shunt

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Post-Fontan pulmonary artery growth in patients with a bidirectional cavopulmonary shunt with additional antegrade pulsatile blood flow

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320984095 ◽

2020 ◽

pp. 021849232098409

Author(s):

Sunita J Ferns ◽

Chawki El Zein ◽

Sujata Subramanian ◽

Tarek Husayni ◽

Michel N Ilbawi

Keyword(s):

Blood Flow ◽

Pulmonary Artery ◽

Pulmonary Blood Flow ◽

Fontan Procedure ◽

Glenn Shunt ◽

Bidirectional Cavopulmonary Shunt ◽

Group 2 ◽

Cavopulmonary Shunt ◽

Group 1

Background Patients with antegrade pulmonary blood flow after a bidirectional cavopulmonary shunt (Glenn) may have better pulmonary artery growth. This study evaluated pulmonary artery growth in patients with and without prior additional pulsatile antegrade flow in a Glenn shunt at midterm follow-up after a Fontan procedure. Methods We reviewed 212 patients who had single-ventricle palliation in a 10-year period;103 (33 in pulsatile group 1 and 70 in nonpulsatile group 2) were selected for analysis. Data on demographics, procedures, perioperative course, and midterm follow-up after the Fontan procedure were compared. Echocardiography data were collected. Pulmonary artery sizes measured at cardiac catheterization and follow-up echocardiograms were used to calculate the Nakata index. Results Perioperative details were comparable in both groups, mean pulmonary artery pressure and systemic oxygen saturations were higher in group 1 compared to group 2. Venovenous collaterals were increased in group 1. There was a significant difference in the pre-Fontan and follow-up Nakata index between groups. There was a significant increase in the Nakata index in group 1 between the pre-Glenn and pre-Fontan assessments as well as the Nakata index between the pre-Fontan and midterm follow-up. There was no significant change in the Nakata index in group 2 between assessments. Conclusions A pulsatile Glenn shunt is associated with better pulmonary artery growth which continues long after the additional pulsatile flow is eliminated. It is possible that the effects of anterograde pulmonary blood flow on pulmonary artery growth in early life continue long after the Fontan completion.

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Long-term results of additional pulmonary blood flow with bidirectional cavopulmonary shunt

10.21203/rs.3.rs-31559/v2 ◽

2020 ◽

Author(s):

Ryosuke Kowatari ◽

Yasuyuki Suzuki ◽

Kazuyuki Daitoku ◽

Ikuo Fukuda

Keyword(s):

Blood Flow ◽

Liver Fibrosis ◽

Pulmonary Blood Flow ◽

Fontan Procedure ◽

Bidirectional Cavopulmonary Shunt ◽

Long Term Follow Up ◽

Pulmonary Arterial ◽

Cavopulmonary Shunt

Abstract Objective: We evaluated additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt and its effects on the Fontan procedure and long-term outcome of Fontan circulation and liver function.Methods: We included 22 patients (16 boys, 6 girls) having undergone bidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean age and body weight were 20 ± 13 months and 7.5 ± 6.5 kg, respectively. We retrospectively evaluated the patients' clinical data, including cardiac catheterization data, liver function, and liver fibrosis markers.Results: All patients were alive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following: the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p < 0.001); systemic ventricle end-diastolic pressure decreased from 11.4 ± 3.2 mmHg to 6.9 ± 3.6 mmHg (p < 0.001); and the pulmonary artery index decreased from 485.1 ± 272.3 to 269.5 ± 100.5 (p = 0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure.Conclusions: The additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt may contribute to pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistance and without ventricle volume overload. The Fontan circulation was well-maintained at the long-term follow-up, while liver fibrosis markers were above their normal values.

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Bidirectional cavopulmonary shunt with additional pulmonary blood flow: a failed or successful strategy?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezs053 ◽

2012 ◽

Vol 42 (3) ◽

pp. 513-519 ◽

Cited By ~ 31

Author(s):

S. Gerelli ◽

C. Boulitrop ◽

M. Van Steenberghe ◽

D. Maldonado ◽

M. Bojan ◽

...

Keyword(s):

Blood Flow ◽

Pulmonary Blood Flow ◽

Successful Strategy ◽

Bidirectional Cavopulmonary Shunt ◽

Cavopulmonary Shunt

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Long-term results of additional pulmonary blood flow with bidirectional cavopulmonary shunt

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01335-4 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Ryosuke Kowatari ◽

Yasuyuki Suzuki ◽

Kazuyuki Daitoku ◽

Ikuo Fukuda

Keyword(s):

Blood Flow ◽

Liver Fibrosis ◽

Pulmonary Blood Flow ◽

Fontan Procedure ◽

Bidirectional Cavopulmonary Shunt ◽

Long Term Follow Up ◽

Pulmonary Arterial ◽

Cavopulmonary Shunt

Abstract Objective We evaluated additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt and its effects on the Fontan procedure and long-term outcome of Fontan circulation and liver function. Methods We included 22 patients (16 boys, 6 girls) having undergone bidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean age and body weight were 20 ± 13 months and 7.5 ± 6.5 kg, respectively. We retrospectively evaluated the patients’ clinical data, including cardiac catheterization data, liver function, and liver fibrosis markers. Results All patients were alive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following: the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p < 0.001); systemic ventricle end-diastolic pressure decreased from 11.4 ± 3.2 mmHg to 6.9 ± 3.6 mmHg (p < 0.001); and the pulmonary artery index decreased from 485.1 ± 272.3 to 269.5 ± 100.5 (p = 0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure. Conclusions The additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt may contribute to pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistance and without ventricle volume overload. The Fontan circulation was well-maintained at the long-term follow-up, while liver fibrosis markers were above their normal values.

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