Definitive palliation with cavopulmonary or aortopulmonary shunts for adults with single ventricle physiology

Objective-To compare the relative merits of cavopulmonary or aortopulmonary shunts, or both, as definitive non-Fontan palliations for patients with si ngle ventricle physiology. Design-Clinical data, EGG, echocardiographic data, surgical records, and av ailable postmortem material were reviewed in all patients with single ventr icle physiology identified from the University of Toronto Congenital Cardia c Centre for Adults (UTCCCA) database who had not undergone a Fontan operat ion. Current status of patients was assessed from clinic reviews and patien t contact. Two groups of patients were identified: those with cavopulmonary shunt (group 1, n = 35); and those with aortopulmonary shunt(s) only (grou p 2, n = 15). Results-50 adults (21 male/29 female) who underwent the last palliation at a median age of 11 pears (range 1 day to 53 years) were identified. During a mean (SD) follow up of 13.0 (6.2) years at the UTCCCA, 19 patients died. Survival is 89.4% and 51.9% at 10 and 20 years, respectively, from the time patients were first seen at UTCCCA, with no differences between the groups . Most recent New York Heart Association (NYHA) classification was I-II in 21 patients, III in 25, and TV in four patients; mean haemoglobin was 190 ( 28) g/l, and oxygen saturation was 82 (4)%, with no group differences. Arrh ythmia developed in 25 patients (atrial flutter/fibrillation in 20 and/or s ustained ventricular tachycardia in ii). Atrial flutter/fibrillation was mo re common in patients in group 2, who also showed a greater decline in vent ricular function with time. Age at last palliation, cardiothoracic ratio, a nd inclusion in group 2 were predictive of atrial flutter/fibrillation, poo r ventricular function predictive of ventricular tachycardia, NYHA class > III, and prior ventricular tachycardia predictive of death. Conclusions-Cavopulmonary or aortopulmonary shunts, or both, provide sustai ned palliation for selected patients with single ventricle physiology. Surv ival for both compares favourably with published Fontan series. Compared to aortopulmonary shunts, cavopulmonary shunts convey a beneficial long term effect on ventricular function. Arrhythmia is a major cause of late morbidi ty in these patients, relating to both ventricular dysfunction and death. O nset of sustained ventricular tachycardia is an ominous sign.