Bidirectional cavopulomanry shunt for cyanotic heart disease: Surgical experience from a developing country

ABSTRACT

The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. This study was conducted to highlight our surgical experience with this procedure in a developing country. A retrospective study was conducted using medical records at the Aga Khan University Hospital, Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography, pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia, post-procedure oxygen saturations and complications were evaluated. A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males [75%] and 2 females [25%]. Ages and weights at operation averaged 5.7 +/- 3.7 years [range 2-14 years] and 18.6 +/- 10.4 kg [range 8.5-35.5 kg] respectively. The most common symptoms were the presence of cyanosis in all [100%] patients followed by recurrent respiratory tract infections in 3 [37.5%] patients. Transthoracic echocardiography revealed 6 [75%] patients with atrial septal defects, 5 [62.5%] with tricuspid atresia, 3 [37.5%] with ventricular septal defects, 3 [37.5%] with malposition of great vessels, 2 [25%] with pulmonary stenosis and 2 [25%] with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 +/- 0.5 [range 1.37-2.80]. All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 +/- 83.6 minutes [range 60-298 minutes]. All patients were ventilated for a mean period of 1.5 +/- 0.7 days [range 1-3 days]. The ICU stay was 3.0 +/- 0.6 days [range 2-5 days] with a total hospital stay of 9.8 +/- 3.8 days [range 7-18 days]. The mean post-procedure oxygen saturation was 82.6 +/- 3.5% [range 76-86%]. The most common post-operative complication was supraventricular arrhythmia in 2 [25.0%] patients. There were no intra-operative or early [within 7 days of procedure] deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association [NYHA] functional class I and one patient in NYHA class II. Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopulmonary anastomosis