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Eur J Cardiothorac Surg 1999;16:104-110
© 1999 Elsevier Science NL

Bi-directional cavopulmonary shunt: is accessory pulsatile flow, good or bad?

Department of Thoracic and Cardiovascular surgery, Laennec Hospital, Paris, France

Corresponding author. Nieuwe Hescheweg 104, NL 5342 EE Oss, The Netherlands. Tel.: +31-412-623213
e-mail: vandewal{at}wxs.nl,

Objective: Evaluation of the effect and long-term outcome of accessory pulsatile blood flow versus classical bi-directional cavopulmonary connection (BCPC). Methods: Retrospective review of the medical and surgical records. Results: Two-hundred and five patients (119 boys, 86 girls) underwent BCPC from 1990 to 1996. Accessory pulsatile flow was present in 68%, flow being maintained through the pulmonary trunc in 46%, systemic-to-pulmonary artery shunt in 13% and mixed in 7%, or patent ductus arteriosus in 2%. Patients with accessory pulsatile flow had lower hospital mortality (3% versus 5%), while mean pulmonary artery pressure (14.1 versus 12.6 mmHg P=0.050) and increase of oxygen saturation (12.4 versus 8.7, P=0.034) were significantly higher. The period of artificial ventilation (1.9 day) and ICU stay (6 days) did not differ for both groups. Late mortality was higher following accessory pulsatile flow (6% versus 1%). At late follow-up patients with accessory pulsatile flow had significantly higher oxygen saturation (mean 85±4%, versus 79±4%; P0.005). If subsequent completion of Fontan is considered the optimal palliation and subsequent systemic to pulmonary artery shunt, arteriovenous fistula and transplantation is considered a failure, patients with accessory pulsatile flow had significantly more and earlier completion of the Fontan procedure (mean 1.7±2.4 years, versus 2.7±4.4 years; P=0.008). Survival is not influenced by age at bi-directional cavopulmonary shunt surgery, left or right functional ventricular anatomy or previous palliative surgery. One patient with accessory pulsatile flow developed systemic-to-pulmonary collateral's eventually requiring lobectomy. Conclusion: Despite two different initial palliative techniques the outcome was not significantly different. Accessory pulsatile blood flow appeared not to be a contra-indication for a completion Fontan procedure. Moreover, the data suggest that after accessory pulsatile flow can safely be performed, at late follow-up oxygen saturation is higher, while, significantly more and earlier completion of Fontan occurred. Age at bi-directional cavopulmonary shunt, basic left or right ventricular anatomy or previous palliative surgery did not influence survival.

Key Words: Functionally single ventricle • Glenn procedure • Pulsatile blood flow • Follow-up

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