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John A. Hawkins
Robert E. Shaddy
Ronald W. Day
Garth S. Orsmond
Edwin C. McGough
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Ann Thorac Surg 1993;56:833-837
© 1993 The Society of Thoracic Surgeons

Articles

Mid-term results after bidirectional cavopulmonary shunts

John A. Hawkins, MD*, Robert E. Shaddy, MD, Ronald W. Day, MD, Jane E. Sturtevant, BSN, Garth S. Orsmond, MD, Edwin C. McGough, MD

Divisions of Cardiothoracic Surgery and Pediatric Cardiology, Departments of Surgery and Pediatrics, Primary Children's Medical Center and The University of Utah School of Medicine, Salt Lake City, Utah USA

* Address reprint requests to Dr Hawkins, Department of Surgery, The University of Utah, 50 North Medical Dr, Salt Lake City, UT 84132.

Despite the increasing use of the bidirectional cavopulmonary shunt, little is known about the late results, the duration of palliation, and the frequency with which this procedure allows later successful conversion to a Fontan type of procedure. We reviewed our experience (1984 to 1992) in 38 consecutive children, ages 4 months to 16 years (mean, 4.0 years), who underwent a bidirectional cavopulmonary shunt procedure. All had a single functional ventricle and represented high risks for the performance of a Fontan procedure based on anatomic and hemodynamic criteria. The oxygen saturation in these patients improved from a preoperative value of 75% ± 7% to 82% ± 7% (p < 0.05) at late cardiac catheterization by a mean of 24 months after operation. The actuarial survival, including early deaths and that associated with all secondary procedures, was 86% at 1 year and 81% at 6 years. Early deaths occurred in 5.3% ( [equation]) and late deaths in 11% ( [equation]). Late follow-up ranged from 5 to 90 months (mean, 37 months). Conversion to a Fontan or fenestrated Fontan procedure was accomplished in 21 early survivors ( [equation]; 58%) by a mean of 26 months after the bidirectional cavopulmonary shunt procedure, with one operative and no late deaths ( [equation]; 4.8%). Three additional patients have undergone late reoperation, including 2 requiring cardiac transplantation and 1 undergoing the late creation of an axillary artery-to-vein fistula for the treatment of cyanosis. The midterm survival after a bidirectional cavopulmonary shunt procedure appears to be excellent, and it serves as a good staging procedure for patients who represent high risks for a Fontan procedure. In some patients, the bidirectional cavopulmonary shunt appears to provide excellait palliation with good intermediate-term results.




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