Impact of hypoxemia and re-interventions on clinical outcomes after bidirectional cavopulmonary shunt. (21st April 2022)

• Record Type: Journal Article
• Authors: Kido, Takashi; Euringer, Caecilia; Burri, Melchior; Vodiskar, Janez; Strbad, Martina; Cleuziou, Julie; Ruf, Bettina; Ewert, Peter; Hager, Alfred; Hörer, Jürgen; Ono, Masamichi
• Is Part Of: European journal of cardio-thoracic surgery. Volume 62:Number 3(2022)
• Publication Date: 2022-04-21
• Subjects: Single ventricle -- Bidirectional cavopulmonary shunt -- Cyanosis; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac266
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: We sought to investigate the impact of early postoperative low arterial oxygen saturation on mortality and morbidity after bidirectional cavopulmonary shunt (BCPS). METHODS: The medical records of all patients who underwent BCPS between 2013 and 2018 were reviewed. RESULTS: A total of 164 patients were included in this study. Forty-seven patients underwent reintervention during hospital stay at median 7 days after BCPS. Before reintervention, 30 patients were intubated or had SpO2 of <75%. All re-interventions for Glenn pathway obstruction and 4 out of 5 venovenous coil embolization resulted in hospital discharge, while high mortality was observed after other re-interventions (atrioventricular valve surgery, thrombolysis, systemic ventricular outflow obstruction relief, extracorporeal membrane oxygenation implantation and diaphragmatic plication). Additional aortopulmonary shunt with pulmonary artery discontinuation was performed in 8 patients who showed severe cyanosis with median SpO2 of 59% under maximal ventilation support. In the univariable Cox regression analysis, the associated factors for mortality before total cavopulmonary connection were reduced ventricular function [hazard ratio (HR) 6.89, 95% confidence interval (CI) 1.76–26.9, P -value 0.006], greater than moderate atrioventricular valve regurgitation (HR 5.89, 95% CI 1.70–20.4, P -value 0.005), SpO2 1 h after extubation (HR 0.87, 95% CI 0.80–0.96, P -value 0.004) and mean pulmonary artery pressure 1 h after extubation (HR 1.14, 95% CI 1.02–1.26, P -value 0.016). CONCLUSIONS: After BCPS, unacceptable cyanosis persisted with various aetiologies. Low arterial oxygen saturation within 1 h after extubation is significantly associated with high mortality after BCPS. Abstract : The bidirectional cavopulmonary shunt (BCPS) is a standard intermediate procedure for patients with various types of the single-ventricle physiology, followed by extra-cardiac total cavopulmonary connection (TCPC) [1–3].