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Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts

^a Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Germany
^b Department of Paediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University Munich, Germany

Received 7 November 2007; received in revised form 28 March 2008; accepted 29 April 2008.

^_* Corresponding author. Address: Clinic of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Lazarettstrasse 36, 80636 Munich, Germany. Tel.: +49 89 12184111; fax: +49 89 12184113. (Email: schreiber{at}dhm.mhn.de).

Objective: Our institutional policy differs from others substantially, as we never leave any additional blood flow at the time of performing bidirectional cavopulmonary connection (BCPC). The aim was to evaluate the influence of this strategy on hemodynamics and pulmonary artery development. Methods: Between 2001 and 2006 a total of 124 patients had completion to a total cavopulmonary connection (TCPC). Review of 84 angiograms before BCPC and TCPC allowed for analysis of hemodynamic findings and measurement of the pulmonary arteries (PA). Results: Mean age at BCPC was 12.6 ± 15.3 months. Mean age at time of TCPC was 31.3 ± 18.7 months, with an interval of 18.6 ± 11.8 months between BCPC and completion to extracardiac TCPC. There was no postoperative mortality after BCPC, one patient died after TCPC (1.2%). The mean oxygen saturation increased after BCPC from 74.4% to 79.6% (p < 0.01). The mean PA pressures decreased after BCPC from 15.1 to 13.5 mmHg (n.s.). The mean left atrial pressure decreased from 5.8 to 4.9 mmHg prior to TCPC (p = 0.06). The pulmonary/systemic blood flow ratio was 1.4 prior to BCPC and decreased to 0.67 prior to TCPC (p = 0.04). The pulmonary/systemic resistance ratio decreased also from 0.19 to 0.07 prior to TCPC (p < 0.01). The right PA, as well as the right lower lobe PA, showed a significant increase in diameter after BCPC (p < 0.01). The left PA also increased in size, although this was not statistically significant. Conclusions: After BCPC without additional blood flow, hemodynamic findings are favorable for completion of TCPC. Our findings support our institutional policy not only for an early staging to a BCPC, but likewise a swift completion towards a TCPC.

Key Words: Congenital heart disease • Partial cavopulmonary connection • Bidirectional cavopulmonary connection • Total cavopulmonary connection