Abstract
Aim of the study – to analyze the mid-term results of a bidirectional cavopulmonary anastomosis (BCPA) performed in young children.
Material and methods. The analysis of the mid-term results of BCPA in children operated in the period from 1993 to 2012 was carried out. The follow-up period ranged from 3 to 195 months (mean 61 months). Mortality, survival, complication rate were considered as primary endpoints. The secondary endpoints were blood oxygen saturation, mean pulmonary artery (PA) pressure, heart contractile function, end-diastolic volume index of the systemic ventricle, pulmonary arterial development indexes. Statistical analysis of the results was carried out by the IBM SPSS Statistics program 22.0.
Results. During the follow-up period, 124 (88.5%) patients out of 140 survivors at the hospital stage were examined (p=0.011). The Fontan operation was carried out in 94 (75.8%); 30 (24.2%) patients were in the «BCPA» status, 15 (12.1%) patients waiting Fontan surgery and 14 (11.3%) there are high risk patients (only 2 of 14 patients retained this status from the moment of BCPA and others patients were included in the main subgroup at the time of BCPA). Mortality was 3.2% (n = 4); overall 2 years survival after BCPA was 96.0%, 3 years – 91.6%, 5 years – 80.6%, 10 years – 80.6%, 15 years – 80.6%. Pulmonary stenosis there are in 12.1% of main cohort patients. One year freedom from pulmonary stenosis was 100%, 2 years – 94.8%, 5 years – 86.2%, 7 years – 75.6%, 10 years – 68.0%, 15 years – 40.8%. McGoon index less than 2 (р = 0.008) and the fact of pulmonary enlargement with patches (р = 0.026) at the time of BCPA were pulmonary stenosis risk factors. There was a trend of the relation between pulmonary arteries decreasing and absence of antegrade pulmonary flow (р = 0.077). The high risk patients at hospital stage had improved pulmonary arterial development indexes (р = 0.001) and stabilization of heart contractile function (р = 0.012) at follow-up period.
Conclusion. In accordance with the results BCPA allows to ensure acceptable survival and quality of life for patients in the mid-term period after surgery, promote to decreasing the consequences of chronic volume heart overload and arterial hypoxemia in most cases, allows to stabilize the pulmonary arteries size and contractile function of the heart in patients with initially reduced pulmonary arteries and ejection fraction of the single ventricle, respectively. It is a very important for high risk patients. There are no specific for BCPA complications and open surgery. Knowing the exact age range for BCPA will optimize the results of the operation and will provide a better functional status for patients. It will be the subject of further work.
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About the authors
- Dmitriy K. Gushchin, Cand. Med. Sci., Researcher, Cardiovascular Surgeon; ORCID
- Mikhail M. Zelenikin, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
- Mikhail A. Zelenikin, Dr. Med. Sci., Leading Researcher, Cardiovascular Surgeon; ORCID
