Spinal surgery in the univentricular heart – is it viable?

Macarrón, César Pérez-Caballero; Ruiz, Elvira Medina; Flores, Jesús Burgos; Martínez, J.; Pérez, Ana Coca; Rojas, Edwin; Ruas, Jj. Sánchez

doi:10.1017/s1047951112002235

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…For this reason preferable these patients must be operated in the Cottrell or in the Jackson table, in which the patient is fastened and the abdomen, and inferior cava vein system, is not compressed [5]. The postoperative complications are frequent being worst the respiratory complications considering that almost all these children are diagnosed of restrictive disorders furthermore their heart disease [6].…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of an Adolescent for Scoliosis Surgery with a Bidirectional Glenn circulation

Dominguez

Burgos

2017

JACCOA

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The relationship between congenital heart disease and scoliosis is well known. Most of these patients present deformities that can be included in the group on spine deformities associated to a congenital heart disease, and, in another patients, the fact of perform a sternotomy in the first infancy to correct partially the heart defect, predisposes to develop the spine deformity. The improvement of the life expectancy in these patients can increase the probability of being operated of non-cardiac surgery. The patients with single ventricle circulation do not have right ventricle, so that, the pulmonary blood flow depends of the central venous pressure. The prone position used for scoliosis correction could worsen the venous return and the cardiac output. We present a 17 years of female patient case, diagnosed of a kippel Feil syndrome and a complex congenital heart disease (dextrocardia, dextroapex, complete atrioventricular septal defect, double outlet right ventricle, transposition of great arteries, pulmonary stenosis and double inferior vena cava system) partially corrected by Glenn surgery at 2 years. She present a toracolumbar scoliosis that causes severe pulmonary restriction and gets worse her functional class. The patient was operated in prone position by posterior approach and the correction using pedicular screws and bars was developed. Hemodynamic invasive monitoring like Transesophageal echocardiogram (TEE) and continuous arterial pressure monitoring were used; somatosensorial evoked potentials were used too. The patient was carried to the intensive care unit hemodinamically stable. As a severe postoperative complication at the second postoperative day she present superior cava vein thrombosis that was not extended to the pulmonary artery anastomosis and that not compromise the Glenn function. She was anticoagulated with unfractionated heparin being the vein successfully recanalized. 10 days after she was discharged to the hospitalization area.

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Section: Discussionmentioning

confidence: 99%

Anaesthetic Management of an Adolescent for Scoliosis Surgery with a Bidirectional Glenn circulation

Dominguez

Burgos

2017

JACCOA

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“…Previous authors have reported anecdotal experiences with the perioperative care of this population during PSF (Table 1) [15][16][17][18][19][20]. The Fontan operation, while providing a corrective procedure for complex cardiac malformations characterized by single ventricle anatomy, leaves the patient's CO dependent on passive PBF.…”

Section: ]mentioning

confidence: 99%

Perioperative Management of a Patient With Fontan Physiology for Posterior Spinal Fusion

Walker

2014

J Med Cases

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The Fontan operation remains a common palliative surgical approach for complex cardiac malformations characterized by single ventricle anatomy. Given improvements in surgical technique and perioperative care, these patients are now living into the second decade of life and beyond. As such, they may require additional surgical procedures to address other co-morbid conditions. We present a 12-year-old girl presenting for posterior spinal fusion for the treatment of scoliosis. She had been born with hypoplastic left heart syndrome and had subsequently undergone successful conversion to Fontan physiology. The authors describe the perioperative preparation and anesthetic management of the patient with Fontan anatomy.

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“…Spinal surgery in patients with CHD has become safer with time, however the risk of perioperative complications remains high 17–21 . This risk is greatest in patients with single ventricle physiology and requires multidisciplinary care and preparation for adverse perioperative events 21–27 . Our institution recently reviewed 78 patients with CHD undergoing scoliosis surgery and found patients with cyanotic single ventricle physiology had the highest risk for adverse perioperative events 21 .…”

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confidence: 99%

“…[17][18][19][20][21] This risk is greatest in patients with single ventricle physiology and requires multidisciplinary care and preparation for adverse perioperative events. [21][22][23][24][25][26][27] Our institution recently reviewed 78 patients with CHD undergoing scoliosis surgery and found patients with cyanotic single ventricle physiology had the highest risk for adverse perioperative events. 21 Our single ventricle physiology cohort has grown since this research and an earlier review of Fontan patients.…”

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confidence: 99%

Surgical Correction of Scoliosis in Children with Severe Congenital Heart Disease and Palliated Single Ventricle Physiology

Cohen

Przybylski

Marshall

et al. 2020

Spine

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Study Design. Case series.Objective. In this study we focus on this group, and describe the largest cohort to date of single ventricle patients undergoing surgical correction of scoliosis at a single institution. Summary of Background Data. Outcomes of spinal surgery for patients with congenital heart disease (CHD) have evolved and most affected patients have uncomplicated procedures. The risk of perioperative complications remains highest in patients with single ventricle (''Fontan") physiology. Methods. We reviewed patients with single ventricle CHD and operative scoliosis repair over a 25-year span. Patients who had undergone a Fontan, bidirectional Glenn, and/or Kawashima procedure before operative scoliosis repair were included. Patients were excluded if they lacked preoperative cardiac care and/or sufficient medical history at our institution. Results. Twenty-three patients were included. The average age at surgery was 13.6 years (range, 5-23). Seventy percent of the cohort was female (16/23). The majority of patients underwent a Fontan before scoliosis surgery (20/23, 87%). Patients without intraoperative tranexamic acid (TXA) had a 67% complication rate (8/12) versus 36% (4/11) in those with intraoperative TXA (P ¼ 0.29). There was a significant difference in estimated blood loss by weight (cc/kg) between non-TXA and TXA patients (P ¼ 0.016). Twelve patients experienced complications (52%), all of which occurred postoperatively. There were no deaths, cerebrovascular events, adverse perioperative cardiac or hemodynamic complications, or wound infections. Using the Clavien-Dindo-Sink classification for postoperative complications, four patients had serious adverse events, including one permanent neurologic deficit. Conclusion. Spinal surgery for scoliosis has been performed in selected patients with single ventricle physiology at a single institution without mortality for 25 years. Operative blood loss may be reduced by routine use of TXA. Complications occur most commonly in the postoperative period, and can include pleural effusion.

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Spinal surgery in the univentricular heart – is it viable?

Abstract: Spinal surgery in patients with Fontan circulation is a high-risk operation. These patients must be managed by a specialised team.

Cited by 8 publications

References 25 publications

Anaesthetic Management of an Adolescent for Scoliosis Surgery with a Bidirectional Glenn circulation

Anaesthetic Management of an Adolescent for Scoliosis Surgery with a Bidirectional Glenn circulation

Perioperative Management of a Patient With Fontan Physiology for Posterior Spinal Fusion

Surgical Correction of Scoliosis in Children with Severe Congenital Heart Disease and Palliated Single Ventricle Physiology

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