Document Detail


Impact of evolving strategy on clinical outcomes and central pulmonary artery growth in patients with bilateral superior vena cava undergoing a bilateral bidirectional cavopulmonary shunt.
MedLine Citation:
PMID:  20621311     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We reported a high incidence of thrombosis, central pulmonary artery hypoplasia, and mortality for bilateral bidirectional cavopulmonary shunts. We hypothesized that technical modifications in the cavopulmonary anastomosis and anticoagulation would limit thrombus and central pulmonary artery hypoplasia, and thereby improve outcomes. METHODS: Sixty-one patients (median age, 8.4 months; weight, 6.6 kg) underwent bilateral bidirectional cavopulmonary shunt from 1990 to 2007. The cohort was divided into 2 groups: 1) the conventional group (1990-1999, n = 37) and 2) the V-shaped group, with a hemi-Fontan or modification in which the cavae were anastomosed to the pulmonary artery adjacent to each other so they formed the appearance of a V (1999-2007, n = 24). Central and branch pulmonary artery growth, survival, and reinterventions were determined. RESULTS: The pre-Fontan study showed equivalent superior venae cavae and Nakata indices. The central pulmonary artery index and central pulmonary artery/Nakata index ratio were significantly higher in the V-shaped group (P < .05). There were no differences in freedom from death or transplant (conventional 69% vs V-shaped 75% at 3 years, P = .5), and a nonsignificant trend toward improving freedom from reinterventions (63% vs 81% at 3 years, P = .15) and thrombosis (82% vs 95% at 1 year, P = .11) was observed in the V-shaped group. Multivariate analysis showed anastomotic strategy, low saturation, and thrombosis were predictors for death. Anastomotic strategy, lack of anticoagulation, thrombosis, and small superior venae cavae were predictors for reintervention (P < .05). Predictors for thrombus included small superior venae cavae, Nakata index, and low saturation (P < .03). CONCLUSIONS: Surgical modifications for bilateral bidirectional cavopulmonary shunts were associated with the larger central pulmonary artery size. Lack of anticoagulation and anastomotic strategy affected reintervention. Anastomotic strategy and postoperative thrombus affected mortality.
Authors:
Osami Honjo; Kim-Chi D Tran; Zhongdong Hua; Priya Sapra; Abdullah A Alghamdi; Jennifer L Russell; Christopher A Caldarone; Glen S Van Arsdell
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-09-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  522-8, 528.e1     Citation Subset:  AIM; IM    
Copyright Information:
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
The Labatt Family Heart Centre, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Chi-Square Distribution
Child, Preschool
Fontan Procedure
Heart Bypass, Right* / adverse effects,  mortality
Humans
Infant
Infant, Newborn
Kaplan-Meiers Estimate
Magnetic Resonance Angiography
Ontario
Pulmonary Artery / growth & development,  radiography,  surgery*
Regression Analysis
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Superior Vena Cava Syndrome / etiology,  prevention & control
Thrombosis / etiology,  prevention & control
Time Factors
Treatment Outcome
Vena Cava, Superior / radiography,  surgery*
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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