The short- and mid-term results of bidirectional cavopulmonary shunt with additional source of pulmonary blood flow as definitive palliation for the functional single ventricular heart

Objective: The purpose of this study was to demonstrate the early and late outcomes of bidirectional cavopulmonary shunt (BCPS) as a definitive proced ure for the functional single ventricular heart. Method: From September 199 1 to December 1997, 34 patients underwent a BCPS procedure without a routin e conversion to Fontan circulation. The additional source of pulmonary bloo d flow was left in all patients. Conversion was performed only when it was required for excessive cyanosis. Results: The hospital mortality rate was 8 .8% (3/34, 95% confidence limit; 1.9-23%) and the 5-year survival rate was 75% for a mean follow-up period of 33 +/- 22 months. Seven patients underwe nt a conversion procedure for remnant or recurrent cyanosis and deteriorati on of exercise tolerance. Four of these patients died after conversion to F ontan circulation. Twenty-five long-term survivors with BCPSs maintained an arterial oxygen saturation of 84 +/- 6.1%, and 52% of them had a normal ex ercise tolerance or mild limitation. No patients developed severe late comp lications other than recurrent cyanosis. Conclusion: Due to the high mortal ity after conversion to Fontan circulation in patients whose conditions had deteriorated, we could not demonstrate the clear superiority of long-term BCPS over the construction of Fontan circulation for management of the func tional single ventricular heart. If deteriorated conditions were successful ly managed in the late period, the outcome of long-term BCPS would have bee n better. (C) 2000 Elsevier Science B.V. All rights reserved.