Evolution of Approaches to Palliative Treatment of Patients with Single-ventricle Physiology and Obstructive Systemic Output in a Single Medium-volume Institution

Anton Avramenko, Sergey Shorokhov, Mikhail Khokhlunov, Irina Kozeva, Sergey Khokhlunov, Vladimir Goryachev

Samara regional clinical cardiac hospital, Samara, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective

Palliative repair in patients with single-ventricle physiology and obstructive systemic output remains a challenge in every stage of the process. The purpose of current study was to evaluate an impact of different management strategies and their evolution on the outcomes.

Methods

63 consecutive newborn patients underwent Stage-I repair during the period from 2005 till 2017. All patients received PGE1 continuous infusion preoperatively. 37 patients developed significant pulmonary ovecirculation with decreased systemic blood flow. 23 of them were successfully managed with medical and respiratory therapy. 14 still had unbalanced circulation and underwent invasive pulmonary blood flow restriction – temporary right pulmonary artery (PA) occlusion (n=3) or bilateral PA banding (n=11).

Surgical stragtegy was different in different time periods. Methods of establishing pulmonary blood flow have changed over time: central shunt in 3 patients (4.7%), modified Blalock-Taussig shunt (MBTS) in 33 (52.4%) and Sano shunt in 27 (42.9%). Perfusion strategy has also changed: deep hypothermic circulatory arrest (DHCA) in 20 patients (31.7%), deep hypothermia and selective antegrade cerebral perfusion (SACP) in 10 (15.9%) and moderate hypothermia with two-regional (coronary and cerebral) perfusion in 33 (52.4%) patients.

Patients were divided into 2 groups: group 1 - MBTS or central shunt AND DHCA or SACP - 30 patients, and group 2 - Sano shunt and two-regional perfusion - 33 patients. Outcomes were compared between groups.

Results

Aortic cross-clamp time in group 1 was 87,2±3,1 min., and in group 2 - 64,8±4,8 min (p=0,001).

Mortality was 53% in group 1 and 20% in group 2 (р=0,02).

Conclusions

Evolution of perfusion strategies and methods of establishing pulmonary blood flow improved outcomes in patients after Stage-I repair.