Additional Pulmonary Blood Flow Has No Adverse Effect on Outcome After TCPC[*]

Abstract

Background: Use of additional sources of pulmonary blood flow (APBF) with bidirectional cavopulmonary anastomosis (BDG) and total cavopulmonary connection (TCPC) remains controversial. We have therefore assessed the effects of APBF on BDG and TCPC outcome. Methods: From 1996 to 2000, 106 patients underwent BDG, either isolated (group 1, n = 54), or with APBF via pulmonary artery (PA) (group 2, n = 30), or Blalock-Taussig shunt (BTS) (group 3, n = 22) with 28 patients completed by TCPC. Results: After BDG low output syndrome was more frequent in group 2 and less in 3 (p = 0.01), whereas superior cava syndrome was again more common in group 2 and less in groups 1 and 3 (p < 0.05) than expected. Mortality and complications were similar after TCPC in all groups. Oxygen saturation (SaO₂) was lower without than with APBF (p < 0.002) after BDG and in group 3 than in group 2 after TCPC (p < 0.05). Repeated measures ANOVA showed no effect of APBF on SaO₂, PA pressures, fractional shortening, end-diastolic pressure and AV-valve function. Conclusions: Early after BDG, APBF via PA presents different difficulties than APBF via BTS. However, BDG and TCPC outcomes are not affected by the presence or absence of APBF.

Congenital heart disease - Glenn anastomosis - total cavopulmonary connection

References

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1 Presented at the 4th joint meeting of the German, Austrian, and Swiss Society for Thoracic and Cardiovascular Surgery, Hamburg, February 15 - 18, 2004