FACTORS INFLUENCING PERIOPERATIVE MORBIDITY DURING PALLIATION OF THE UNIVENTRICULAR HEART

Background. The modified Fontan procedure has become the treatment of choice for patients born with a univentricular heart. Although the ope rative mortality has steadily decreased in recent years, the hospital stay is still prolonged in many patients due to fluid retention and pl eural effusions. Methods. We retrospectively analyzed subsets of patie nts undergoing the bidirectional cavopulmonary shunt (BDCPS) and modif ied Fontan procedure in an attempt to define factors influencing opera tive mortality and morbidity. Results. Multivariate analysis of 64 pat ients undergoing BDCPS revealed that age 6 months or less, concomitant operation, mean pulmonary pressure of 15 mm Hg or less, and mean pulm onary artery ratio of 1.8:1 or less were not statistically significant indicators of risk. Abnormal pulmonary artery architecture was a sign ificant predictor of early and late death (p less than or equal to 0.0 1). Retrospective analysis of 71 patients undergoing the modified Font an procedure revealed no significant relationship between duration of pleural effusions and age at operation, pre-operative oxygen saturatio n, pulmonary artery pressure, ventricular end-diastolic pressure, or p rior BDCPS. Patients with important aortopulmonary collateral vessels defined by angiography had prolonged pleural drainage. Selective use o f the total extracardiac conduit and the fenestrated Fontan resulted i n low overall mortality with no statistical differences between subset s of patients undergoing different modifications of the Fontan procedu re. Conclusions. These data indicate that the operative risk for BDCPS or modified Fontan procedure is quite low if a procedure appropriate for the patient is selected. Abnormal pulmonary artery architecture is an important risk factor for death after the BDCPS. Aortopulmonary co llateral vessels are associated with fluid retention and pleural effus ions after a modified Fontan procedure. Important aortopulmonary colla teral vessels should be occluded before or during the modified Fontan procedure.