Risk Factors for Development of Aortopulmonary Collaterals during Staged Single-Ventricle Reconstruction

Background: Development of aortopulmonary collateral arteries (APCs) is common in patients with single-ventricle (SV) physiology. This study was aimed to evaluate the incidence of APCs during staged palliation and to identify risk factors for the development of APCs using clinical variables.

Method: A total of 430 patients who underwent staged palliation by means of bidirectional cavopulmonary shunt (BCPS) and total cavopulmonary connection (TCPC) at our center between 2003 and 2019 were included. The presence of APCs was determined with routine cardiac catheterization before BCPS and TCPC. Risk factors for the development of APCs were examined using clinical variables.

Results: Main diagnosis included hypoplastic left heart syndrome (HLHS) in 141 (26%) patients, tricuspid atresia in 60 (14%), and double inlet left ventricle in 46 (11%). Dominant right ventricle was observed in 254 (59%) patients. Median age at stage I palliation was 12 (IQR: 8–21) days, and Norwood procedure was performed in 251 (50%) patients, followed by systemic to pulmonary shunt in 91 (21%) patients and pulmonary artery banding in 47 (11%) patients. Median age at BCPS was 4.9 (3.5–7.7) months and median age at TCPC was 2.2 (1.7–2.8) years. APCs were observed at BCPS in 56 (13%) patients and at TCPC in 179 (42%) patients. Interventional closure of APCs was performed in 12 (3%) patients before TCPC, in 7 (2%) patients after BCPS, in 46 (11%) before TCPC, and in 52 (12%) after TCPC. Surgical closure of APCs was performed in 13 (3%) patients at BCPS and 26 (6%) at TCPC. Risk factor analysis for development of APCs at BCPS revealed that HLHS (52 vs. 30%, p < 0.01) and Norwood procedure as stage I palliation (70 vs. 47%, p < 0.01) were identified as risks. Risk factor analysis for the development of APCs at TCPC demonstrated that Norwood procedure (56 vs. 46%, p = 0.02) and pre-TCPC lower Nakata Index (164 vs. 191 mm²/m², p < 0.01) were identified as risks.

Conclusion: In a total of 430 patients, the APCs were developed in 13% of patients before BCPS and in 42% before TCPC. HLHS and Norwood procedure as stage 1 palliation were identified as risk factors for the development of APCs before BCPS and Norwood procedure for APCs development before TCPC. Patients who demonstrated APCs before TCPC had significant lower PA Index (Nakata index).

Publication History

Article published online:
03 February 2022