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Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients : analysis of risk factors for morbidity and mortality, and suitability for Fontan completion

Katrien Francois (UGent) , Kristof Vandekerckhove (UGent) , Katya De Groote (UGent) , Joseph Panzer (UGent) , Daniël De Wolf (UGent) , Hans De Wilde (UGent) and Thierry Bové (UGent)
(2016) CARDIOLOGY IN THE YOUNG. 26(2). p.288-297
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Abstract
Objectives: The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion. Methods: A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary - mortality and survival to Fontan completion - and secondary outcome endpoints - re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1-3 interventions had preceded. Norwood-type procedures became more prevalent over time. Results: Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion. Conclusion: The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained.
Keywords
LEFT-HEART SYNDROME, PULMONARY BLOOD-FLOW, INHALED NITRIC-OXIDE, post-operative management, paediatric cardiac surgery, single ventricle, Congenital heart disease, ARTERIOVENOUS-MALFORMATIONS, GLENN ANASTOMOSIS, ADDITIONAL SOURCE, INFANTS, SHUNT, PALLIATION, CONNECTION

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MLA
Francois, Katrien et al. “Current Outcomes of the Bi-directional Cavopulmonary Anastomosis in Single Ventricle Patients : Analysis of Risk Factors for Morbidity and Mortality, and Suitability for Fontan Completion.” CARDIOLOGY IN THE YOUNG 26.2 (2016): 288–297. Print.
APA
Francois, K., Vandekerckhove, K., De Groote, K., Panzer, J., De Wolf, D., De Wilde, H., & Bové, T. (2016). Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients : analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. CARDIOLOGY IN THE YOUNG, 26(2), 288–297.
Chicago author-date
Francois, Katrien, Kristof Vandekerckhove, Katya De Groote, Joseph Panzer, Daniël De Wolf, Hans De Wilde, and Thierry Bové. 2016. “Current Outcomes of the Bi-directional Cavopulmonary Anastomosis in Single Ventricle Patients : Analysis of Risk Factors for Morbidity and Mortality, and Suitability for Fontan Completion.” Cardiology in the Young 26 (2): 288–297.
Chicago author-date (all authors)
Francois, Katrien, Kristof Vandekerckhove, Katya De Groote, Joseph Panzer, Daniël De Wolf, Hans De Wilde, and Thierry Bové. 2016. “Current Outcomes of the Bi-directional Cavopulmonary Anastomosis in Single Ventricle Patients : Analysis of Risk Factors for Morbidity and Mortality, and Suitability for Fontan Completion.” Cardiology in the Young 26 (2): 288–297.
Vancouver
1.
Francois K, Vandekerckhove K, De Groote K, Panzer J, De Wolf D, De Wilde H, et al. Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients : analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. CARDIOLOGY IN THE YOUNG. 2016;26(2):288–97.
IEEE
[1]
K. Francois et al., “Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients : analysis of risk factors for morbidity and mortality, and suitability for Fontan completion,” CARDIOLOGY IN THE YOUNG, vol. 26, no. 2, pp. 288–297, 2016.
@article{7138778,
  abstract     = {Objectives: The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion. 
Methods: A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary - mortality and survival to Fontan completion - and secondary outcome endpoints - re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1-3 interventions had preceded. Norwood-type procedures became more prevalent over time. 
Results: Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion. 
Conclusion: The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained.},
  author       = {Francois, Katrien and Vandekerckhove, Kristof and De Groote, Katya and Panzer, Joseph and De Wolf, Daniël and De Wilde, Hans and Bové, Thierry},
  issn         = {1047-9511},
  journal      = {CARDIOLOGY IN THE YOUNG},
  keywords     = {LEFT-HEART SYNDROME,PULMONARY BLOOD-FLOW,INHALED NITRIC-OXIDE,post-operative management,paediatric cardiac surgery,single ventricle,Congenital heart disease,ARTERIOVENOUS-MALFORMATIONS,GLENN ANASTOMOSIS,ADDITIONAL SOURCE,INFANTS,SHUNT,PALLIATION,CONNECTION},
  language     = {eng},
  number       = {2},
  pages        = {288--297},
  title        = {Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients : analysis of risk factors for morbidity and mortality, and suitability for Fontan completion},
  url          = {http://dx.doi.org/10.1017/S1047951115000153},
  volume       = {26},
  year         = {2016},
}

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