McElhinney D B, Marianeschi S M, Reddy V M
Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.
Ann Thorac Surg. 1998 Aug;66(2):668-72. doi: 10.1016/s0003-4975(98)00581-5.
The bidirectional cavopulmonary shunt has become a mainstay in the palliation of patients with a functional single-ventricle heart. However, there remain a number of unresolved issues regarding this procedure, many of which concern the response of the pulmonary vasculature to this unique circulatory physiology. Among the issues of debate are the role and effects of an additional source of pulmonary blood flow.
Between January 1990 and April 1997, 160 patients underwent bidirectional cavopulmonary anastomosis. Median age at operation was 7.8 months, and age ranged from 24 days to 43 years. An additional source of pulmonary blood flow was included in 93 patients (58%). A retrospective review of our experience with this cohort was performed with a focus on the role of additional pulmonary blood flow.
Eight patients (5%) died in the early postoperative period, and the overall early failure rate (death or take-down) was 7.5% (n=12). Eleven other patients underwent early reoperation to decrease (n=8) or increase (n=3) the amount of pulmonary blood flow. Early survivors were followed up for a median of 23 months, during which time 5 patients died and 30 patients underwent Fontan completion. Including early and late mortality, actuarial survival rates at 1 and 2 years were 91% and 88%, respectively.
The bidirectional cavopulmonary shunt is a useful procedure in the early or intermediate-term management of patients with a functional univentricular heart. However, there is much still to be learned about this unique physiologic system. The role of accessory pulmonary blood flow remains unclear, as does the use of the bidirectional cavopulmonary shunt as long-term palliation. Pulmonary arteriovenous fistulas are a serious concern, especially in young patients with heterotaxy syndrome.
双向腔肺分流术已成为功能性单心室心脏患者姑息治疗的主要手段。然而，关于该手术仍存在许多未解决的问题，其中许多问题涉及肺血管系统对这种独特循环生理学的反应。有争议的问题包括额外肺血流来源的作用和影响。
1990年1月至1997年4月期间，160例患者接受了双向腔肺吻合术。手术时的中位年龄为7.8个月，年龄范围为24天至43岁。93例患者（58%）有额外的肺血流来源。对该队列的经验进行了回顾性分析，重点关注额外肺血流的作用。
8例患者（5%）在术后早期死亡，总体早期失败率（死亡或拆除手术）为7.5%（n = 12）。另外11例患者接受了早期再次手术，以减少（n = 8）或增加（n = 3）肺血流量。早期存活者的中位随访时间为23个月，在此期间5例患者死亡，30例患者接受了Fontan手术。包括早期和晚期死亡率，1年和2年的精算生存率分别为91%和88%。
双向腔肺分流术在功能性单心室心脏患者的早期或中期管理中是一种有用的手术。然而，关于这种独特的生理系统仍有许多需要了解的地方。辅助肺血流的作用仍不清楚，双向腔肺分流术作为长期姑息治疗的应用也不明确。肺动静脉瘘是一个严重问题，尤其是在患有内脏异位综合征的年轻患者中。
