MIDTERM RESULTS AFTER BIDIRECTIONAL CAVOPULMONARY SHUNTS

Despite the increasing use of the bidirectional cavopulmonary shunt, l ittle is known about the late results, the duration of palliation, and the frequency with which this procedure allows later successful conve rsion to a Fontan type of procedure. We reviewed our experience (1984 to 1992) in 38 consecutive children, ages 4 months to 16 years (mean, 4.0 years), who underwent a bidirectional cavopulmonary shunt procedur e. All had a single functional ventricle and represented high risks fo r the performance of a Fontan procedure based on anatomic and hemodyna mic criteria. The oxygen saturation in these patients improved from a preoperative value of 75% +/- 7% to 82% +/- 7% (p < 0.05) at late card iac catheterization by a mean of 24 months after operation. The actuar ial survival, including early deaths and that associated with all seco ndary procedures, was 86% at 1 year and 81% at 6 years. Early deaths o ccurred in 5.3% (2/38) and late deaths in 11% (4/36). Late follow-up r anged from 5 to 90 months (mean, 37 months). Conversion to a Fontan or fenestrated Fontan procedure was accomplished in 21 early survivors ( 21/36; 58%) by a mean of 26 months after the bidirectional cavopulmona ry shunt procedure, with one operative and no late deaths (1/21; 4,8%) . Three additional patients have undergone late reoperation, including 2 requiring cardiac transplantation and 1 undergoing the late creatio n of an axillary artery-to-vein fistula for the treatment of cyanosis. The midterm survival after a bidirectional cavopulmonary shunt proced ure appears to be excellent, and it serves as a good staging procedure for patients who represent high risks for a Fontan procedure. In some patients, the bidirectional cavopulmonary shunt appears to provide ex cellent palliation with good intermediate-term results.