Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective
Objectives: Severe hypoxemia in the early postoperative period after bidirectional cavopulmonary shunt (BCPS) is a critical complication. We aimed to evaluate patients who underwent additional systemic to pulmonary shunt and septation of central pulmonary artery (partial takedown) after BCPS. Method...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622002789 |
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| author | Caecilia Euringer, MS Takashi Kido, MD, PhD Bettina Ruf, MD Melchior Burri, MD, PhD Paul Philipp Heinisch, MD, PhD Janez Vodiskar, MD Martina Strbad, MSc Julie Cleuziou, MD, PhD Daniel Dilber, MD, PhD Alfred Hager, MD, PhD Peter Ewert, MD, PhD Jürgen Hörer, MD, PhD Masamichi Ono, MD, PhD |
| author_facet | Caecilia Euringer, MS Takashi Kido, MD, PhD Bettina Ruf, MD Melchior Burri, MD, PhD Paul Philipp Heinisch, MD, PhD Janez Vodiskar, MD Martina Strbad, MSc Julie Cleuziou, MD, PhD Daniel Dilber, MD, PhD Alfred Hager, MD, PhD Peter Ewert, MD, PhD Jürgen Hörer, MD, PhD Masamichi Ono, MD, PhD |
| author_sort | Caecilia Euringer, MS |
| collection | DOAJ |
| description | Objectives: Severe hypoxemia in the early postoperative period after bidirectional cavopulmonary shunt (BCPS) is a critical complication. We aimed to evaluate patients who underwent additional systemic to pulmonary shunt and septation of central pulmonary artery (partial takedown) after BCPS. Methods: The medical records of all patients who underwent BCPS between 2007 and 2020 were reviewed. Patients who underwent partial takedown were extracted and their outcomes were analyzed. Results: Of 441 BCPS patients, 27 patients (6%) required partial takedown. Most frequent diagnosis was hypoplastic left heart syndrome (n = 14; 52%). Additional complicating factors included pulmonary artery hypoplasia (n = 12) and pulmonary venous obstruction (n = 3). Thirteen patients (48%) underwent partial takedown on the same day of BCPS, and all of them survived the procedure. The remaining 14 patients (52%) underwent partial takedown between postoperative 1 to 64 days. The reasons for partial takedown were: postoperative high pulmonary vascular resistance (n = 4), early BCPS (<90 days) with PA hypoplasia (n = 3), mediastinitis/pneumonia (n = 3), pulmonary venous obstruction (n = 2), ventricular dysfunction (n = 1), and recurrent pneumothorax (n = 1). Four patients experienced hospital deaths. Six patients died after discharge, 10 achieved Fontan completion, and 6 were alive and waiting for Fontan. Overall survival after partial takedown was 54% at 3 years. The pulmonary venous obstruction (P = .041) and genetic/extracardiac anomalies (P = .085) were identified as risks for mortality after partial takedown. Conclusions: The partial takedown resulted in a 3-year survival rate of more than 50%. Of these patients, a significant number underwent successful Fontan completion who would exhibit potential early death with conservative treatment. |
| first_indexed | 2024-12-10T12:56:16Z |
| format | Article |
| id | doaj.art-14fca00e56644c3c84cbe58e9e659391 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-12-10T12:56:16Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-14fca00e56644c3c84cbe58e9e6593912022-12-22T01:48:05ZengElsevierJTCVS Open2666-27362022-09-0111373387Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspectiveCaecilia Euringer, MS0Takashi Kido, MD, PhD1Bettina Ruf, MD2Melchior Burri, MD, PhD3Paul Philipp Heinisch, MD, PhD4Janez Vodiskar, MD5Martina Strbad, MSc6Julie Cleuziou, MD, PhD7Daniel Dilber, MD, PhD8Alfred Hager, MD, PhD9Peter Ewert, MD, PhD10Jürgen Hörer, MD, PhD11Masamichi Ono, MD, PhD12Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Pediatrics, University Hospital Centre Zagreb, School of Medicine Zagreb, Zagreb, CroatiaDepartment of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, GermanyDepartment of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-University of Munich, Munich, Germany; Address for reprints: Masamichi Ono, MD, PhD, Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany.Objectives: Severe hypoxemia in the early postoperative period after bidirectional cavopulmonary shunt (BCPS) is a critical complication. We aimed to evaluate patients who underwent additional systemic to pulmonary shunt and septation of central pulmonary artery (partial takedown) after BCPS. Methods: The medical records of all patients who underwent BCPS between 2007 and 2020 were reviewed. Patients who underwent partial takedown were extracted and their outcomes were analyzed. Results: Of 441 BCPS patients, 27 patients (6%) required partial takedown. Most frequent diagnosis was hypoplastic left heart syndrome (n = 14; 52%). Additional complicating factors included pulmonary artery hypoplasia (n = 12) and pulmonary venous obstruction (n = 3). Thirteen patients (48%) underwent partial takedown on the same day of BCPS, and all of them survived the procedure. The remaining 14 patients (52%) underwent partial takedown between postoperative 1 to 64 days. The reasons for partial takedown were: postoperative high pulmonary vascular resistance (n = 4), early BCPS (<90 days) with PA hypoplasia (n = 3), mediastinitis/pneumonia (n = 3), pulmonary venous obstruction (n = 2), ventricular dysfunction (n = 1), and recurrent pneumothorax (n = 1). Four patients experienced hospital deaths. Six patients died after discharge, 10 achieved Fontan completion, and 6 were alive and waiting for Fontan. Overall survival after partial takedown was 54% at 3 years. The pulmonary venous obstruction (P = .041) and genetic/extracardiac anomalies (P = .085) were identified as risks for mortality after partial takedown. Conclusions: The partial takedown resulted in a 3-year survival rate of more than 50%. Of these patients, a significant number underwent successful Fontan completion who would exhibit potential early death with conservative treatment.http://www.sciencedirect.com/science/article/pii/S2666273622002789bidirectional cavopulmonary shuntcyanosisadditional systemic-to-pulmonary-artery shuntpulmonary artery hypoplasiapulmonary venous obstructiontakedown |
| spellingShingle | Caecilia Euringer, MS Takashi Kido, MD, PhD Bettina Ruf, MD Melchior Burri, MD, PhD Paul Philipp Heinisch, MD, PhD Janez Vodiskar, MD Martina Strbad, MSc Julie Cleuziou, MD, PhD Daniel Dilber, MD, PhD Alfred Hager, MD, PhD Peter Ewert, MD, PhD Jürgen Hörer, MD, PhD Masamichi Ono, MD, PhD Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective JTCVS Open bidirectional cavopulmonary shunt cyanosis additional systemic-to-pulmonary-artery shunt pulmonary artery hypoplasia pulmonary venous obstruction takedown |
| title | Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective |
| title_full | Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective |
| title_fullStr | Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective |
| title_full_unstemmed | Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective |
| title_short | Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective |
| title_sort | management of failing bidirectional cavopulmonary shunt influence of additional systemic to pulmonary artery shunt with classic glenn physiologycentral messageperspective |
| topic | bidirectional cavopulmonary shunt cyanosis additional systemic-to-pulmonary-artery shunt pulmonary artery hypoplasia pulmonary venous obstruction takedown |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622002789 |
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