Early results and risk factors of bidirectional cavopulmonary anastomosis in children

Dmitriy K. Guschin, Mikhail M. Zelenikin, Sergey S. Volkov, Mikhail A. Zelenikin

National scientific and practical center for cardiovascular surgery named after A.N. Bakulev of the Ministry of health of the Russian Federation, Moscow, Russia

Date, time and location: 2018.05.26 13:30, Exhibition area, 1st Floor. Zone – D

Abstract

OBJECTIVE. The aim of this study is to analyze early results of bidirectional cavopulmonary anastomosis (BCPA) in children and to determine the risk factors of the procedure for this age group of patients.

METHODS. A retrospective analysis was undertaken of 156 patients in median age 24 months. Multivariate regression analysis was used to determine risk factors.

RESULTS. Hospital mortality – 10.3%. The main cause of death was thromboembolic events (TEE) – 43.8%. Predictors of death: systemic ventricle ejection fraction (SV EF) after surgery less than 56% (OR 25.64; 95% CI 2.20-333.33;р=0.036), mechanical ventilation (MV) more than 6.5 days (ОR 38.97; 95% CI 3.31-459.23;р=0.004); predictors of TEE– SV EF after surgery less than 56% (ОR 9.17; 95% CI 1.26-66.67;р=0.029), MV more than 8.5 days (ОR 61.37; 95% CI 6.14-613.95; р<0.0001). There was a significant decrease of the SV EF after surgery in comparison with the initial value. The initial value of the end-diastolic volume index (EDVi) more than 97 ml/m² is defined as the risk factor of the SV EF decrease after surgery (ОR 7.69; 95% CI 1.59-37.04; р=0.011). The most frequent non-lethal complications: neurological disorders (ND) – 19.3%, respiratory insufficiency (RI) – 14.3%, superior vena cava syndrome (SVCS) – 11.4%. Predictors of ND: mean pulmonary artery pressure (PAPmean) more than 13 mmHg (ОR 4.07; 95% CI 1.33-12.49; р=0.014), MV more than 45 hours (ОR 20.71; 95% CI 6.43-66.71; р<0.0001). Predictors of RI: aortic cross-clamping more than 21 minutes (ОR 26.32; 95% CI 1.66-500; р=0.02), MV more than 35 hours (ОR 76.92; 95% CI 9.17-1000; р<0.0001). Predictor of SVCS– PAPmean more than 15 mmHg (ОR 13.51; 95% CI 4.29-43.48; р<0.0001).

CONCLUSIONS. BCPA implementation at earlier age group patients without ventricle dilation could be more preferable due to mortality risk reduction. Early weaning from mechanical ventilation can reduce morbidity after surgery.