Modifications to the cavopulmonary anastomosis do not eliminate early sinus node dysfunction

Cohen, Mitchell I.; Bridges, Nancy D.; Gaynor, J. William; Hoffman, Timothy M.; Wernovsky, Gil; Vetter, Victoria L.; Spray, Thomas L.; Rhodes, Larry A.

doi:10.1067/mtc.2000.109708

Cited by 88 publications

(53 citation statements)

References 17 publications

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“…As with other types of congenital heart operations, SAND in these patients may be related to SA node injury from the atriotomy incision, venous cannulation, acquired coronary arterial insufficiency to the SA node, or right atrial stretch. SAND has been associated with the stage II palliation known as the “hemi-Fontan operation” 16, 17 . This procedure was not performed in any patients in our series, including the single patient who developed SAND following stage II.…”

Section: Discussionmentioning

confidence: 99%

Arrhythmias in patients with hypoplastic left heart syndrome

Trivedi

Smith

Barker

et al. 2011

American Heart Journal

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Background Mortality between stage I and II palliation for hypoplastic left heart syndrome (HLHS) has been associated with arrhythmias. The stage-related proportion, associations, and clinical impact of arrhythmias in patients with HLHS have not been evaluated. Also, arrhythmia subtypes have not been described in this patient group. Methods We performed a retrospective analysis of all patients at Duke University Medical Center who received one or more palliative stages for hypoplastic left heart syndrome from September 2000 to October 2008. Results Overall, 49/86 (57%) patients had 63 arrhythmias. The majority of arrhythmias occurred between stage I and II with 44/86 (51%) patients manifesting a new arrhythmia. Arrhythmias occurring in this interval tended to be associated with a higher mortality compared to arrhythmias occurring after stage II, OR = 3.2 [95%CI 0.84, 12.0] (p=0.09). Overall, mortality was similar in patients with and without arrhythmias (p=0.99). Supraventricular tachycardia was the most common arrhythmia (16/63; 25%) but persistent bradycardias (sinus node dysfunction or high grade atrioventricular block) had the worst clinical outcome with 73% mortality (8/11). There was no association between arrhythmia occurrence and degree of tricuspid regurgitation, left ventricular hypertension, genetic syndrome, type of stage I operation, or need for extracorporeal membrane oxygenation (ECMO). Conclusions A large proportion of patients with HLHS experience serious arrhythmias requiring therapy, especially between stages I and II. Persistent bradycardia following stage I is associated with a high mortality rate. Considering all arrhythmia patients, overall mortality was not different compared to the arrhythmia free group.

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Section: Discussionmentioning

confidence: 99%

Arrhythmias in patients with hypoplastic left heart syndrome

Trivedi

Smith

Barker

et al. 2011

American Heart Journal

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“…Following a hemi-Fontan procedure, the Fontan completion is usually performed by creation of an intra-atrial lateral tunnel. There is no conclusive evidence that the type of superior cavopulmonary connection (i.e., Glenn vs. hemi-Fontan) has a significant impact on late outcomes for patients with HLHS (185,190,191). …”

Section: Stage II (Glenn; Hemi-fontan)mentioning

confidence: 99%

Hypoplastic Left Heart Syndrome

Feinstein

Benson

Dubin

et al. 2012

Journal of the American College of Cardiology

439

176

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In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). During this time, survival to the age of 5 years (including Fontan) has ranged from 50% to 69%, but current expectations are that 70% of newborns born today with HLHS may reach adulthood. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. In this white paper, we present the current state of the art in our understanding and treatment of HLHS during the stages of care: 1) pre-Stage I: fetal and neonatal assessment and management; 2) Stage I: perioperative care, interstage monitoring, and management strategies; 3) Stage II: surgeries; 4) Stage III: Fontan surgery; and 5) long-term follow-up. Issues surrounding the genetics of HLHS, developmental outcomes, and quality of life are addressed in addition to the many other considerations for caring for this group of complex patients.

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“…Our long-term findings support previous studies showing no significant difference in the longterm underlying rhythm either by type of superior cavopulmonary connection or type of Fontan. 19,20 …”

Section: Commentmentioning

confidence: 99%

Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

et al. 2012

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AbstractBackgroundA superior cavopulmonary connection is commonly performed before the Fontan procedure in patients with a functionally univentricular heart. Data are limited regarding associations between a prior superior cavopulmonary connection and functional and ventricular performance late after the Fontan procedure.MethodsWe compared characteristics of those with and without prior superior cavopulmonary connection among 546 subjects enrolled in the Pediatric Heart Network Fontan Cross-Sectional Study. We further compared different superior cavopulmonary connection techniques: bidirectional cavopulmonary anastomosis (n equals 229), bilateral bidirectional cavopulmonary anastomosis (n equals 39), and hemi-Fontan (n equals 114).ResultsA prior superior cavopulmonary connection was performed in 408 subjects (75%); the proportion differed by year of Fontan surgery and centre (p-value less than 0.0001 for each). The average age at Fontan was similar, 3.5 years in those with superior cavopulmonary connection versus 3.2 years in those without (p-value equals 0.4). The type of superior cavopulmonary connection varied by site (p-value less than 0.001) and was related to the type of Fontan procedure. Exercise performance, echocardiographic variables, and predominant rhythm did not differ by superior cavopulmonary connection status or among superior cavopulmonary connection types. Using a test of interaction, findings did not vary according to an underlying diagnosis of hypoplastic left heart syndrome.ConclusionsAfter controlling for subject and era factors, most long-term outcomes in subjects with a prior superior cavopulmonary connection did not differ substantially from those without this procedure. The type of superior cavopulmonary connection varied significantly by centre, but late outcomes were similar.

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Modifications to the cavopulmonary anastomosis do not eliminate early sinus node dysfunction

Abstract: Avoidance of surgery near the sinus node has no discernible effect on the development of early sinus node dysfunction. Thus, concerns about early sinus node dysfunction should not override patient anatomy or surgeon preference as determinants of which cavopulmonary anastomosis to perform.

Cited by 88 publications

References 17 publications

Arrhythmias in patients with hypoplastic left heart syndrome

Arrhythmias in patients with hypoplastic left heart syndrome

Hypoplastic Left Heart Syndrome

Cardiac performance and quality of life in patients who have undergone the Fontan procedure with and without prior superior cavopulmonary connection

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