Changes in pulmonary artery index and its relation to outcome after stage II palliation in patients with hypoplastic left heart syndrome

OBJECTIVE

This study aimed to prove if pulmonary artery size influences survival and if an additional aortopulmonary shunt promotes left pulmonary artery growth after bidirectional cavopulmonary shunt in patients with hypoplastic left heart syndrome.

METHODS

The medical records of patients with hypoplastic left heart syndrome who underwent Norwood procedure and bidirectional cavopulmonary shunt between 2007 and 2020 were reviewed. Right, left, and total (right + left) pulmonary artery indices were calculated according to Nakata and colleagues.

RESULTS

A total of 158 patients were included in this study. Median age at Norwood and bidirectional cavopulmonary shunt was 8 (7-11) days and 3.6 (3.1-4.6) months, respectively. There were 7 hospital deaths and 12 late deaths. Survival after bidirectional cavopulmonary shunt was 90.3% at 1 year, and 86.2% at 2 years. Total, right, and left pulmonary artery indices were 238 (195-316), 136 (101-185), and 102 (75-130) mm2/m2 at the time of bidirectional cavopulmonary shunt, and they were 237 (198-284), 151 (123-186), and 86 (69-108) mm2/m2 at the time of Fontan. Left pulmonary artery index decreased significantly between the time of bidirectional cavopulmonary shunt and Fontan (p < 0.01). Nine patients needed partial takedown and additional aortopulmonary shunt due to failing bidirectional cavopulmonary shunt, but the additional aortopulmonary shunt did not promote the pulmonary artery growth significantly.

CONCLUSIONS

Preoperative pulmonary artery index did not affect the mortality after bidirectional cavopulmonary shunt. The partial takedown and additional aortopulmonary shunt for failing bidirectional cavopulmonary shunt were unable to improve left pulmonary artery size.

Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiology

Objectives

Methods

Results

Conclusions

Impact of hypoxemia and re-interventions on clinical outcomes after bidirectional cavopulmonary shunt

OBJECTIVES

We sought to investigate the impact of early postoperative low arterial oxygen saturation on mortality and morbidity after bidirectional cavopulmonary shunt.

METHODS

The medical records of all patients who underwent bidirectional cavopulmonary shunt between 2013 and 2018 were reviewed.

RESULTS

A total of 164 patients were included in this study. Forty-seven patients underwent reintervention during hospital stay at median 7 days after bidirectional cavopulmonary shunt. Before reintervention, 30 patients were intubated or had SpO2 of less than 75%. All re-interventions for Glenn pathway obstruction and 4 out of 5 venovenous coil embolization resulted in hospital discharge, while high mortality was observed after other re-interventions (atrioventricular valve surgery, thrombolysis, systemic ventricular outflow obstruction relief, extracorporeal membrane oxygenation implantation, and diaphragmatic plication). Additional aortopulmonary shunt with pulmonary artery discontinuation was performed in 8 patients who showed severe cyanosis with median SpO2 of 59% under maximal ventilation support. In univariable Cox regression analysis, the associated factors for mortality before total cavopulmonary connection were reduced ventricular function (HR 6.89, 95% CI 1.76-26.9, P value 0.006), greater than moderate atrioventricular valve regurgitation (HR 5.89, 95% CI 1.70-20.4, P value 0.005), SpO2 1 hour after extubation (HR 0.87, 95% CI 0.80-0.96, P value 0.004), and mean pulmonary artery pressure 1 hour after extubation (HR 1.14, 95% CI 1.02-1.26, P value 0.016).

CONCLUSIONS

After bidirectional cavopulmonary shunt, unacceptable cyanosis persisted with various etiologies. Low arterial oxygen saturation within 1 hour after extubation is significantly associated with high mortality after bidirectional cavopulmonary shunt.