Tags

Type your tag names separated by a space and hit enter

Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion.
Cardiol Young. 2016 Feb; 26(2):288-97.CY

Abstract

OBJECTIVES

The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion.

METHODS

A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary - mortality and survival to Fontan completion - and secondary outcome endpoints - re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1-3 interventions had preceded. Norwood-type procedures became more prevalent over time.

RESULTS

Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion.

CONCLUSION

The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained.

Authors+Show Affiliations

1Department of Congenital Cardiac Surgery,The Cardiac Centre,University Hospital Gent,Belgium.2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.1Department of Congenital Cardiac Surgery,The Cardiac Centre,University Hospital Gent,Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25704070

Citation

François, Katrien, et al. "Current Outcomes of the Bi-directional Cavopulmonary Anastomosis in Single Ventricle Patients: Analysis of Risk Factors for Morbidity and Mortality, and Suitability for Fontan Completion." Cardiology in the Young, vol. 26, no. 2, 2016, pp. 288-97.
François K, Vandekerckhove K, De Groote K, et al. Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. Cardiol Young. 2016;26(2):288-97.
François, K., Vandekerckhove, K., De Groote, K., Panzer, J., De Wolf, D., De Wilde, H., & Bové, T. (2016). Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. Cardiology in the Young, 26(2), 288-97. https://doi.org/10.1017/S1047951115000153
François K, et al. Current Outcomes of the Bi-directional Cavopulmonary Anastomosis in Single Ventricle Patients: Analysis of Risk Factors for Morbidity and Mortality, and Suitability for Fontan Completion. Cardiol Young. 2016;26(2):288-97. PubMed PMID: 25704070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. AU - François,Katrien, AU - Vandekerckhove,Kristof, AU - De Groote,Katya, AU - Panzer,Joseph, AU - De Wolf,Daniel, AU - De Wilde,Hans, AU - Bové,Thierry, Y1 - 2015/02/23/ PY - 2015/2/24/entrez PY - 2015/2/24/pubmed PY - 2016/10/19/medline KW - Congenital heart disease KW - paediatric cardiac surgery KW - post-operative management KW - single ventricle SP - 288 EP - 97 JF - Cardiology in the young JO - Cardiol Young VL - 26 IS - 2 N2 - OBJECTIVES: The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion. METHODS: A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary - mortality and survival to Fontan completion - and secondary outcome endpoints - re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1-3 interventions had preceded. Norwood-type procedures became more prevalent over time. RESULTS: Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion. CONCLUSION: The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained. SN - 1467-1107 UR - https://www.unboundmedicine.com/medline/citation/25704070/Current_outcomes_of_the_bi_directional_cavopulmonary_anastomosis_in_single_ventricle_patients:_analysis_of_risk_factors_for_morbidity_and_mortality_and_suitability_for_Fontan_completion_ L2 - https://www.cambridge.org/core/product/identifier/S1047951115000153/type/journal_article DB - PRIME DP - Unbound Medicine ER -