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Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation

Published online by Cambridge University Press:  10 September 2018

Shuichi Shiraishi ,
Toshihide Nakano ,
Shinichiro Oda  and
Hideaki Kado
Shuichi Shiraishi*
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Toshihide Nakano
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Shinichiro Oda
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
Hideaki Kado
Affiliation:
Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, Fukuoka, Japan
*
Author for correspondence: S. Shiraishi, MD, Department of Cardiovascular Surgery, Fukuoka Children’s Hospital, 5-1-1 Kashii Teruha, Higashi-ku, Fukuoka 813-0017, Japan. Tel: +81-92-682-7000; Fax: +81-92-682-7300; E-mail: sshuichi@med.niigata-u.ac.jp
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Abstract

Backgrounds

The aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection.

Methods

We conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67).

Results

The proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044).

Conclusions

Early bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

Keywords

Bidirectional cavopulmonary anastomosistiming of operationpost-operative haemodynamics
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 12 , December 2018 , pp. 1436 - 1443
Copyright
© Cambridge University Press 2018 

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