Transcatheter Creation of Bidirectional Cavopulmonary Connections in Adults

Background: A bidirectional cavopulmonary connection is a well-established surgical procedure in young children with univentricular hearts (UVH). In adults, however, it is rarely performed and if so, then as an adjunct to other cardiac operations.

Is there a role for the transcatheter creation of a bilateral PCPC (cathPCPC) in adults with low pulmonary vascular resistance but compromised pulmonary blood supply?

Method: Six patients were selected for a cathPCPC: three had Ebstein's anomaly or tricuspid valve dysplasia, two had UVH, and one right ventricular hypoplasia. Patients’ ages were 18 to 62 years (median: 52 years). Median mean pulmonary artery pressure was 15 mm Hg (8–20 mm Hg).

The PCPC were performed in two steps: First the implantation of a bare metal stent in the superior vena cava (SVC). Second, several weeks later, direct needle puncture from the SVC to the right pulmonary artery (RPA) and, consecutively, the implantation of covered stents between SVC and RPA.

Results: The procedure was technical successful in all patients. Mean follow-up period is 14 months (1 week to 31 months). One patient died 2.5 months after the procedure as a result of his endstage cardiac disease, and one patient showed recurrent cardiac decompensation due to rhythm disturbances. Two patients reported an improvement of exercise tolerance. In one patient with cyanosis due to a LSVC without bridging vein the cathPCPC and the occlusion of collaterals led to a 10% point increase of oxygen saturation; NT-proBNP levels improved in three of six patients.

Conclusion: CathPCPC in adults is feasible and shows an improvement of hemodynamics in some patients. A controlled study or registry with defined criteria for inclusion and evaluation should be the next steps to explore the potential of a cathPCPC as a palliative measure in adults with low pulmonary vascular resistance and compromised pulmonary blood flow.

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

Publication History

Article published online:
28 January 2023