Behrend Lea, Schaeffer Thibault, Osawa Takuya, Palm Jonas, Di Padua Chiara, Niedermaier Carolin, Heinisch Paul Philipp, Piber Nicole, Hager Alfred, Ewert Peter, Hörer Jürgen, Ono Masamichi
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany.
Cardiol Young. 2024 Oct;34(10):2122-2131. doi: 10.1017/S1047951124025502. Epub 2024 Sep 19.
We have left antegrade pulmonary blood flow (APBF) at bidirectional cavopulmonary shunt (BCPS) only for high-risk patients. This study evaluates the indication and the outcomes of patients with APBF, compared to those without APBF.
Patients with APBF after BCPS were identified among patients who underwent BCPS between 1997 and 2022. Outcomes of patients with and without APBF after BCPS were compared.
APBF was open in 38 (8.2%) of 461 patients. Median age (7.7 versus 6.3 months, p = 0.55) and weight (5.6 versus 6.1 kg, p = 0.75) at BCPS were similar in both groups. The most frequent indication for APBF was high pulmonary artery pressure (PAP) in 14 patients, followed by hypoxaemia in 10, and hypoplastic left pulmonary artery in 8. The source of APBF was the pulmonary trunk in 10 patients and the aortopulmonary shunt in 28. Median hospital stay after BCPS was longer (22 versus 14 days, p = 0.018) and hospital mortality was higher (10.5 versus 2.1%, p = 0.003) in patients with APBF compared to those without APBF. However, 448 hospital survivors showed similar survival after discharge following BCPS (p = 0.224). Survival after total cavopulmonary connection (TCPC) was similar between the groups (p = 0.753), although patients with APBF were older at TCPC compared to those without (3.9 versus 2.2 years, p = 0.010).
APBF was left in 8% following BCPS in high-risk patients, mainly due to preoperative high PAP. Hospital survivors after BCPS demonstrated comparable survival in patients with and without APBF. Adding APBF at BCPS might be a useful option for high-risk patients.
我们仅在双向腔肺分流术（BCPS）时为高危患者保留了顺行性肺血流（APBF）。本研究评估了有APBF与无APBF患者的适应证及预后情况。
在1997年至2022年间接受BCPS的患者中识别出BCPS术后有APBF的患者。比较BCPS术后有和无APBF患者的预后情况。
461例患者中有38例（8.2%）保留了APBF。两组患者BCPS时的中位年龄（7.7个月对6.3个月，p = 0.55）和体重（5.6 kg对6.1 kg，p = 0.75）相似。保留APBF最常见的适应证是14例患者肺动脉压（PAP）高，其次是10例低氧血症患者和8例左肺动脉发育不全患者。APBF的来源，10例患者为肺动脉干，28例为主动脉-肺动脉分流术。与无APBF的患者相比，有APBF的患者BCPS术后中位住院时间更长（22天对14天，p = 0.018），住院死亡率更高（10.5%对2.1%，p = 0.003）。然而，448例住院幸存者在BCPS出院后的生存率相似（p = 0.224）。两组患者在全腔肺连接（TCPC）后的生存率相似（p = 0.753），尽管有APBF的患者在TCPC时的年龄比无APBF的患者大（3.9岁对2.2岁，p = 0.010）。
高危患者BCPS术后8%保留了APBF，主要原因是术前PAP高。BCPS术后的住院幸存者中，有和无APBF的患者生存率相当。在BCPS时保留APBF可能是高危患者的一个有用选择。
