Ono Masamichi, Burri Melchior, Mayr Benedikt, Anderl Lisa, Cleuziou Julie, Strbad Martina, Hager Alfred, Hörer Jürgen, Lange Rüdiger
Department of Pediatric and Congenital Heart Surgery, German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Lazarettstraße 36, 80636, Munich, Germany.
Pediatr Cardiol. 2020 Apr;41(4):816-826. doi: 10.1007/s00246-020-02318-x. Epub 2020 Mar 10.
Bilateral superior vena cava (SVC), which occurs following bilateral bidirectional cavopulmonary shunt (BCPS), is an anomaly marked by unique hemodynamics. This study aimed to determine its effects on outcomes after Fontan completion. Among 405 patients who underwent BCPS and total cavopulmonary connection (TCPC) between 1997 and 2017, 40 required a bilateral-BCPS. The dominant SVC prior to TCPC was identified according to the direction of blood flow in the central pulmonary artery, and its relationship to the inferior vena cava (IVC) was classified as a concordant or discordant relationship. Preoperative factors were analyzed to identify the risk factors for specific adverse outcomes. The length of intensive care unit (ICU) stay after TCPC was longer in the 40 patients who underwent bilateral-BCPS than in those who underwent unilateral BCPS (p = 0.024), and the survival rate was lower in the former group than in the latter group (p = 0.004). In the patients who underwent bilateral-BCPS, the dominant SVC was concordant with the IVC in 30 patients and discordant in 10 patients. With regard to whether certain morphological, hemodynamic, and flow dynamics-related variables were risk factors for adverse outcomes following TCPC, a discordant relationship between dominant SVC and IVC was identified as an independent risk factor for both a longer ICU stay (p = 0.037, HR 2.370) and worse survival (p = 0.019, HR 13.880). Therefore, in patients with a bilateral SVC who have previously undergone bilateral-BCPS, a discordant relationship between dominant SVC and IVC might contribute to worse outcomes following TCPC.
双侧上腔静脉（SVC）发生于双侧双向腔肺分流术（BCPS）之后，是一种具有独特血流动力学特征的异常情况。本研究旨在确定其对Fontan手术完成后结局的影响。在1997年至2017年间接受BCPS和全腔肺连接（TCPC）的405例患者中，40例需要进行双侧BCPS。根据中央肺动脉内的血流方向确定TCPC术前的优势SVC，并将其与下腔静脉（IVC）的关系分为一致或不一致关系。分析术前因素以确定特定不良结局的危险因素。接受双侧BCPS的40例患者TCPC术后重症监护病房（ICU）住院时间长于接受单侧BCPS的患者（p = 0.024），且前一组的生存率低于后一组（p = 0.004）。在接受双侧BCPS的患者中，优势SVC与IVC一致的有30例，不一致的有10例。关于某些形态学、血流动力学和血流动力学相关变量是否为TCPC术后不良结局的危险因素，优势SVC与IVC之间的不一致关系被确定为ICU住院时间延长（p = 0.037，HR 2.370）和生存情况较差（p = 0.019，HR 13.880）的独立危险因素。因此，在先前接受双侧BCPS的双侧SVC患者中，优势SVC与IVC之间的不一致关系可能导致TCPC术后结局更差。
