Abstract
Objective. Experience of bidirectional cavopulmonary anastomosis (BCPA) implementation, which is widely
recognized as the main intermediate stage of surgical treatment of patients with univentricular hearts, has more
than one decade. But results of the BCPA are far from ideal. Besides early mortality, which significantly higher
than zero according to the majority of works, a significant contribution to the results are made by non-lethal
complications, determining the quality of patients life after surgery. The aim of the study was to analyze the
early results of BCPA in young children and to determine risk factors for mortality and complications.
Material and methods. Retrospective study included 156 patients (median (Me) of age – 24 months, weight –
10 kg), which were operated from October 1993 to December 2012. The spectrum of congenital heart defects
included both anomalies with single-ventricular physiology (single ventricle, tricuspid atresia) and biventricular
complex anomalies. Blood saturation varied from 45 to 94% (Me 75), ejection fraction of the systemic
ventricle (EF SV) – from 36 to 89% (Me 66), end-diastolic volume index of SV was 20 to 327 ml/m2 (average
113.2), Nakata index ranged from 91 to 1117 mm2/m2 (Me 340), McGoon index was from 1.0 to 4.3
(2.2 on average), mean pulmonary artery pressure (PAP) ranged from 5 to 32 mm Hg (Me 12). One-sided
BCPA is performed in 130 cases, double-sided – in 26. Statistical analysis of the results was carried out by
the IBM SPSS Statistics program 22.0.
Results. Hospital mortality was 10.3% (n=16). The most frequent triggering factor of death (43.8%) was
thromboembolic events (TEE). According to the data of multiple regression analysis predictors of the TEE
were the EF SV decrease after surgery less than 56% (p=0.029) and an increase in the duration of mechanical
ventilation (MV) more than 8.5 days (p<0.0001). Predictor of durable MV (more than 4 days) was the weight
of patients at the time of surgery (p=0.01). The most frequent non-lethal complications were neurologic disorders
(n=27; 19.3%), respiratory insufficiency (n=20; 14.3%), upper vena cava syndrome (n=9; 6.4%).
According to the data of the multiple analysis predictors of neurologic disorders were PAP after surgery more
than 13 mm Hg (p=0.014), MV for more than 45 hours (p<0.0001); risk factors for respiratory failure – aorta
clamping more than 21 minutes (p=0.02), MV more than 35 hours (p<0.0001); risk factor for upper vena
cava syndrome – PAP after surgery more than 15 mm Hg (p<0.0001). There was a significant decrease in EF
SV after operation in comparison with the initial value. The initial value of the index of the end-diastolic volume
of the SV more than 97 ml/m2 determined as a risk factor of the EF SV decrease after surgery (p=0.011).
Conclusion. BCPA implimentation at an early age is more preferable and can reduce the risk of mortality.
Early weaning from MV is justified and promotes to reduce the complications rate after surgery.
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About the authors
- Gushchin Dmitriy Konstantinovich, Researcher, Cardiac Surgeon; orcid.org/0000-0002-0925-6526
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Zelenikin Mikhail Mikhaylovich, Dr. Med. Sc., Professor, Chief of the Department of Congenital Heart Diseases Surgery in Young Children, Cardiac Surgeon; orcid.org/0000-0002-1298-2940
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Zelenikin Mikhail Anatol'evich, Dr. Med. Sc., Professor, Leading Researcher, Cardiac Surgeon; orcid.org/0000-0002-9350-8641
