Comparison of Patients with and without Antegrade Pulmonary Blood Flow after Bidirectional Cavopulmonary Shunt Procedure

Background: Advantage of antegrade pulmonary blood flow (APBF) in the bidirectional cavopulmonary shunt (BCPS) remains controversial. We have kept the institutional policy to eliminate all APBF at the time of BCPS, but APBF was included in selected patients. In the current literature, the opinions vary widely whether APBF is related to short term morbidity or to potential long-term benefit. This study aims to compare the patients with and without APBF at the time of BCPS.

Methods: A total of 461 non-Norwood patients who underwent BCPS between 1997 and 2020 were retrospectively reviewed. Patients with hypoplastic left heart syndrome and its variant who underwent the Norwood procedure were excluded from this study. Patients were divided into two groups: patients with APBF left after BCPS procedure and those without. Between the groups the pre- and postoperative measurements were compared to evaluate the influence of APBF on outcomes after BCPS.

Results: The most frequent main diagnosis was 127 univentricular hearts, followed by 97 tricuspid atresias, 82 double inlet left ventricles, and 32 pulmonary atresia with intact ventricular septa. APBF was left in 38 (8.3%) patients. The median age (7.7 vs. 6.3 months, p = 0.55) and weight (5.6 vs. 6.1 kg, p = 0.75) at BCPS were similar between the groups, but median cardiopulmonary bypass time (73 vs. 63 minutes, p < 0.01) was significantly longer in patients with APBF compared to those without ABBF. Median intensive care unit stay (6 vs. 5 days, p = 0.01) and hospital stay (22 vs. 14 days, p < 0.01) were longer in patients with APBF compared to those without ABBF. When outcomes after total cavopulmonary connection (TCPC) were compared in 29 patients with APBF versus 380 patients without APBF, mean pulmonary artery pressure (mPAP, 12.0 vs. 9.3 mmHg, p < 0.01) and left atrial pressure (LAP, 6.4 vs. 5.4 mmHg, p = 0.03) before TCPC were higher in patients with APBF. At TCPC, patients with APBF were older compared to those without APBF compared to those without ABBF (3.9 vs. 2.2 years, p = 0.01). Survival after TCPC was similar between the groups (p = 0.82).

Conclusion: Among 461 patients who underwent BCPS, APBF was left in 8% of the patients. Patients with APBF had longer CPB time at BCPS and needed postoperatively longer intensive care stay and hospital stay. At the time of TCPC, patients with APBF had higher mPAP and higher LAP. TCPC was performed later in patients with APBF, but survival after TCPC was comparable.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024