Effects of controlled antegrade pulmonary blood flow on cardiac function after bidirectional cavopulmonary anastomosis

Abstract

Background Bidirectional cavopulmonary anastomosis (BCPA) has been used as an intermediate stage in the treatment of patients with single-ventricle physiology. Leaving additional antegrade pulmonary blood flow has been shown to improve postoperative arterial blood oxygen saturations; however, controversy continues over whether the potential increase in systemic venous pressure is detrimental. We studied the effects of controlled antegrade pulmonary blood flow on cardiac function in patients after BCPA. Methods From January 1993 to July 2000, 128 patients underwent BCPA. Mean age at operation was 6.2 ± 4 months (range 2 to 36 months). In group 1 (n = 72), restricted antegrade pulmonary blood flow was maintained through a native narrowed pulmonary valve or by adjustment of previously placed pulmonary artery band with the goal of maintaining the mean pulmonary artery pressure less than 16 mm Hg. In group 2 (n = 56), BCPA was the only source of pulmonary blood flow. Results One hospital death (0.8%) occurred. The mean pulmonary artery pressure at the end of the operation was 13 ± 2 mm Hg in group 1 compared with 12 ± 2 mm Hg in group 2, a difference that was not significant. Patients in group 1 had higher arterial oxygen saturations (84% ± 3% compared with 74% ± 3% in group 2, p < 0.05), and shorter mean hospital stay (9 ± 3 days compared with 15 ± 2 days, p < 0.05). Persistent pleural effusion (> 10 days) or late chylothorax occurred in 4 patients from group 1 and 3 from group 2, a difference that was not significant. During a mean follow-up of 36 ± 10 months no late deaths occurred. The mean oxygen saturation remained higher in group 1, 80% ± 3% compared with 74% ± 4% in group 2, and the hematocrit was lower, at 38% ± 3% compared with 46% ± 4% ( p < 0.05 for both comparisons). Cardiac catheterizations were performed in 68 patients before completion Fontan. Total pulmonary artery (Nakata) index was 263 ± 34 mm 2/m 2 in group 1 (n = 40) and 188 ± 13 mm 2/m 2 in group 2 (n = 28) ( p < 0.05). The mean pulmonary artery pressure and mean ventricular end-diastolic pressure were similar. Conclusions Controlled antegrade pulmonary blood flow may have favorable effects on cardiac function for a selected group of patients and does not appear to have adverse effects on subsequent suitability for completion Fontan.