ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Factors affecting the clinical outcomes in patients with bidirectional cavopulmonary anastomosis
Canan Ayabakan1, Özlem Sarısoy1, Bülent Sarıtaş2, Emre Özker2, Ali Can Vuran2, Kürşad Tokel1, Rıza Türköz2
1Başkent Üniversitesi İstanbul Sağlık Uygulama ve Araştırma Merkezi, Pediatrik Kardiyoloji Bölümü, İstanbul, Türkiye
2Başkent Üniversitesi İstanbul Sağlık Uygulama ve Araştırma Merkezi, Kalp ve Damar Cerrahisi Bölümü, İstanbul, Türkiye
DOI : 10.5606/tgkdc.dergisi.2013.8237
Background: In this study, we aimed to investigate factors which affect the clinical outcomes in patients with various pathologies undergoing bidirectional cavopulmonary anastomosis (BCPA).

Methods: Between June 2007 and February 2012, 50 patients (32 boys, 18 girls; mean age 19.7±20.6 months; range 2 to 96 months) who underwent BCPA were retrospectively evaluated. Age, dominant ventricle, atrioventricular valve regurgitation, pulmonary vascular flow at diagnosis (increased/decreased) mean pulmonary artery pressure (mPAP) before BCPA, ventricular ejection fraction (EF) and fractional shortening (FS) and oxygen saturation (satO2) were noted. The relationship between these parameters and monitorization in intensive care unit (ICU), duration of intubation and the amount of inotropic agents were studied.

Results: A total of 24% of the patients with a mean operation age of 19.7±20.6 months were younger than six months old. At the time of diagnosis, pulmonary blood flow was decreased (pulmonary stenosis group; PS) in 72% and increased (pulmonary hypertension group; PH) in 28%. Thirty-five patients had dominant left ventricles, while 15 patients had dominant right ventricles. Preoperative mPAP was 14.9±3.4 mmHg. A significant increase in SatO2 w as o bserved a fter B CPA o peration (from 76.2±9.4% to 81.2±6.9%; p=0.003). The length of stay in the ICU, duration of intubation and the amount of inotropic agents were statistically higher in patients who were younger than six months old and those with decreased pulmonary blood flow (p<0.05). A negative correlation was observed between preoperative satO2 and duration of ICU and the amount of inotropic agent (p<0.05). Patients were followed for 29.4±16.2 months after BCPA operation. Four patients died during follow-up. Three of these patients were younger than six months old and all were in the PS group. The pulmonary artery index (PAI) was significantly lower in the patients who died (184.9±20.4 vs. 235.4±93.1 p<0.05).

Conclusion: Our study results show that early BCPA operation (<6 months old) and decreased pulmonary blood flow at diagnosis increases postoperative morbidity, whereas lower PAI is effective on postoperative mortality.

Keywords : Bidirectional cavopulmonary shunt; clinical outcome; infant
Viewed : 10729
Downloaded : 2217