Outcomes After Bidirectional Cavopulmonary Shunt in Infants Less Than 6 Months Old

Reddy, V. Mohan; McElhinney, Doff B.; Moore, Phillip; Haas, Gary S.; Hanley, Frank L.

doi:10.1016/s0735-1097(97)00068-5

Cited by 83 publications

(59 citation statements)

References 15 publications

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“…23,24 Bradley et al 23 noted that lower systemic oxygenation at the time of preoperative cardiac catheterization as well as elevated pulmonary vascular resistance were significantly associated with death. Reddy et al 24 reported only 2 early postoperative deaths (out of 42 patients), both associated with poor oxygen saturation; 1 of 3 late postoperative deaths (out of 37 patients) was also associated with poor oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

Brain Versus Lung: Hierarchy of Feedback Loops in Single-Ventricle Patients With Superior Cavopulmonary Connection

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Brain Versus Lung: Hierarchy of Feedback Loops in Single-Ventricle Patients With Superior Cavopulmonary Connection

et al. 2004

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“…This approach reduces morbidity and mortality at the time of the Fontan procedure 1,2 and is well tolerated Several series suggest the median length of hospital stay (LOS) is 5–7 days and there are relatively few complications 3–8 . Despite the generally excellent results there are a number of preoperative risk factors associated with prolonged LOS, hospital death, or failure of the cavopulmonary circulation to provide adequate oxygenation and/or acceptable hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial

Schwartz

Lü

Ohye

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objectives The Single Ventricle Reconstruction trial randomized patients with single right ventricle lesions to a modified Blalock-Taussig or right ventricle-to-pulmonary artery shunt at the Norwood. This analysis describes outcomes at the stage II procedure and factors associated with a longer hospital length of stay (LOS). Methods We examined the association of shunt type with stage II hospital outcomes. Cox regression and bootstrapping were used to evaluate risk factors for longer LOS. We also examined characteristics associated with in-hospital death. Results There were 393 subjects in the analytic cohort. Median stage II procedure hospital LOS (8 days, IQR (6,14)), hospital mortality (4.3%), transplantation (0.8%), median ventilator time (2 days, IQR (1,3)), median intensive care unit LOS (4 days (IQR (3,7)), number of additional cardiac procedures or complications and serious adverse events did not differ by shunt type. Longer LOS was associated (R2=0.26) with center, longer post-Norwood LOS (HR 1.93 per log day, P<0.001), non-elective timing of the stage II procedure (HR 1.78, P<0.001) and pulmonary artery (PA) stenosis (HR 1.56, P<0.001). By univariate analysis, non-elective stage II (65% vs. 32%, P=0.009), ≥ moderate atrioventricular valve (AVV) regurgitation (75% vs. 24%, P<0.001) and AVV repair (53% vs. 9%, P<0.001) were among the risk factors associated with in-hospital death. Conclusions Norwood LOS, PA stenoses and non-elective stage II procedure, but not shunt type, are independently associated with longer LOS. Non-elective stage II, >moderate AVV regurgitation and need for AVV repair are among the risk factors for death.

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“…In the current era, short-and mid-term outcomes after SCPC are quite favorable: 30 day operative mortality is as low as 0.7% [12]. Studies with longer follow-up report survival in [85% of patients [19,22,23]. However, ventricular function as a preoperative risk factor has not been examined closely in these studies, and the proportion of patients with significant ventricular dysfunction in each cohort has not been reported.…”

Section: Discussionmentioning

confidence: 97%

Outcomes of Infants Undergoing Superior Cavopulmonary Connection in the Presence of Ventricular Dysfunction

et al. 2011

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Outcomes in patients with ventricular dysfunction undergoing superior cavopulmonary connection (SCPC) are not well known. We reviewed records of patients undergoing SCPC at our center from December 2005 to October 2009 and studied those whose pre-SCPC echocardiograms demonstrated at least moderate systemic ventricular dysfunction. Of the 213 patients undergoing SCPC, 19 (9%) met inclusion criteria. Diagnoses were hypoplastic left heart syndrome (n = 18) and rightward unbalanced atrioventricular canal with pulmonary stenosis (n = 1). In those surviving >2 months after SCPC, ventricular function was assessed by echocardiography 4.9 (range 3.5 to 9.7) months after SCPC and was improved in ten of 17 (59%), unchanged in six of 17 (35%), and worsened in one of 17 (16%) patients. After SCPC, three patients died, and one underwent heart transplant 21.9 months after SCPC. Transplant-free survival was attained by 15 of 19 (79%) patients during follow-up of 33.0 months (range 10.8 to 51.4). Fontan completion was performed on six survivors on reaching an appropriate age. Ventricular dysfunction before SCPC is not uncommon and occurs primarily in patients with a morphologic right ventricle. Ventricular performance improves in the majority of patients after SCPC, and midterm outcomes are comparable with previous reports, suggesting that these patients remain candidates for staged palliation.

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Outcomes After Bidirectional Cavopulmonary Shunt in Infants Less Than 6 Months Old

Abstract: Outcomes after BCPS in young infants are comparable to those in older infants and children. However, our current preference is to defer this procedure until after 2 months of age.

Cited by 83 publications

References 15 publications

Brain Versus Lung: Hierarchy of Feedback Loops in Single-Ventricle Patients With Superior Cavopulmonary Connection

Brain Versus Lung: Hierarchy of Feedback Loops in Single-Ventricle Patients With Superior Cavopulmonary Connection

Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial

Outcomes of Infants Undergoing Superior Cavopulmonary Connection in the Presence of Ventricular Dysfunction

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