Impact of evolving strategy on clinical outcomes and central pulmonary artery growth in patients with bilateral superior vena cava undergoing a bilateral bidirectional cavopulmonary shunt

The Journal of Thoracic and Cardiovascular Surgery
Osami HonjoGlen Van Arsdell

Abstract

We reported a high incidence of thrombosis, central pulmonary artery hypoplasia, and mortality for bilateral bidirectional cavopulmonary shunts. We hypothesized that technical modifications in the cavopulmonary anastomosis and anticoagulation would limit thrombus and central pulmonary artery hypoplasia, and thereby improve outcomes. Sixty-one patients (median age, 8.4 months; weight, 6.6 kg) underwent bilateral bidirectional cavopulmonary shunt from 1990 to 2007. The cohort was divided into 2 groups: 1) the conventional group (1990-1999, n = 37) and 2) the V-shaped group, with a hemi-Fontan or modification in which the cavae were anastomosed to the pulmonary artery adjacent to each other so they formed the appearance of a V (1999-2007, n = 24). Central and branch pulmonary artery growth, survival, and reinterventions were determined. The pre-Fontan study showed equivalent superior venae cavae and Nakata indices. The central pulmonary artery index and central pulmonary artery/Nakata index ratio were significantly higher in the V-shaped group (P < .05). There were no differences in freedom from death or transplant (conventional 69% vs V-shaped 75% at 3 years, P = .5), and a nonsignificant trend toward improving freedom from reint...Continue Reading

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Citations

Dec 3, 2014·The Annals of Thoracic Surgery·Yusuke AndoToshiro Iwai
Nov 28, 2013·The Journal of Thoracic and Cardiovascular Surgery·Ryan R DaviesChristian Pizarro
May 28, 2015·The Annals of Thoracic Surgery·Matteo TrezziMinoo N Kavarana
Jul 4, 2016·The Journal of Thoracic and Cardiovascular Surgery·Osami Honjo
Apr 1, 2011·World Journal for Pediatric & Congenital Heart Surgery·Marshall L Jacobs, Constantine Mavroudis
Dec 27, 2017·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Arnav AgarwalTapas Kumar Mondal
Sep 14, 2017·World Journal for Pediatric & Congenital Heart Surgery·Nataliya R NichayAlexander M Karaskov
Oct 20, 2017·Interactive Cardiovascular and Thoracic Surgery·Ashraf A H El MidanyAhmed M E Aletreby
Mar 8, 2019·World Journal for Pediatric & Congenital Heart Surgery·Eitan KeizmanAlain E Serraf
Mar 11, 2021·Seminars in Thoracic and Cardiovascular Surgery·Masamichi OnoRüdiger Lange
Apr 26, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Kenta ImaiHajime Ichikawa
Jul 1, 2020·The Journal of Thoracic and Cardiovascular Surgery·Shuhua LuoOsami Honjo

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