Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiologyCentral MessagePerspective
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
Affiliations
Caecilia Euringer, MS
Department 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
Takashi Kido, MD, PhD
Department 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
Bettina Ruf, MD
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
Melchior Burri, MD, PhD
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
Paul Philipp Heinisch, MD, PhD
Department 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
Janez Vodiskar, MD
Department 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
Martina Strbad, MSc
Department 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
Julie Cleuziou, MD, PhD
Department 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
Daniel Dilber, MD, PhD
Department of Pediatrics, University Hospital Centre Zagreb, School of Medicine Zagreb, Zagreb, Croatia
Alfred Hager, MD, PhD
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
Peter Ewert, MD, PhD
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Munich, Germany
Jürgen Hörer, MD, PhD
Department 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
Masamichi Ono, MD, PhD
Department 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.