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Right arrow Congenital - cyanotic

J Thorac Cardiovasc Surg 2004;127:982-989
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Early cavopulmonary anastomosis in very young infants after the Norwood procedure: Impact on oxygenation, resource utilization, and mortality

Robert D. B. Jaquiss, MDa,b,*, Nancy S. Ghanayem, MDb,c, George M. Hoffman, MDb,c,d, Raymond T. Fedderly, MDb,e, Joseph R. Cava, MD, PhDb,c, Kathleen A. Mussatto, RN, BSNb, James S. Tweddell, MDa,b

a Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis, USA
b Children's Hospital of Wisconsin, Milwaukee, Wis, USA,
c Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, Wis, USA
d Division of Pediatric Anesthesia, Medical College of Wisconsin, Milwaukee, Wis, USA
e Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wis, USA

Read at the Twenty-ninth Annual Meeting of The Western Thoracic Surgical Association, Carlsbad, Calif, June 18-21, 2003.

Received for publication June 16, 2003; revisions received September 30, 2003; revisions received October 6, 2003; accepted for publication October 28, 2003.

* Address for reprints: Robert D. B. Jaquiss, MD, 9000 W Wisconsin Ave, M.S. 715, Milwaukee, WI 53226, USA
rjaquiss{at}chw.org

BACKGROUND: The optimal timing of second-stage palliation after Norwood operations remains undefined. Advantages of early cavopulmonary anastomosis are early elimination of volume load and shortening the high-risk interstage period. Potential disadvantages include severe cyanosis, prolonged pleural drainage and hospitalization, and excess mortality. We reviewed our recent experience to evaluate the safety of early cavopulmonary anastomosis.

METHODS: Eighty-five consecutive patients undergoing post–Norwood operation cavopulmonary anastomosis were divided into group I (cavopulmonary anastomosis at <4 months; n = 33) and group II (cavopulmonary anastomosis at >4 months; n = 52). Groups were compared for age; size; early and late mortality; preoperative, initial postoperative, and discharge oxygen saturation; and duration of mechanical ventilation, intensive care unit stay, pleural drainage, and hospitalization.

RESULTS: Group I patients were younger than group II patients (94 ± 21 days vs 165 ± 44 days, respectively; P < .001) and smaller (4.8 ± 0.8 kg vs 5.8 ± 0.9 kg; P < .001). The preoperative oxygen saturation was not different (group I, 75% ± 10%; group II, 78% ± 8%; P = .142). The oxygen saturation was lower immediately after surgery in group I compared with group II (75% ± 7% vs 81% ± 7%, respectively; P < .001) but not by discharge (group I, 79% ± 4%; group II, 80% ± 4%). Younger patients were ventilated longer (62 ± 86 hours vs 19 ± 42 hours; P = .001), in the intensive care unit longer (130 ± 111 hours vs 104 ± 94 hours; P = .049), hospitalized longer (12.5 ± 11.5 days vs 10.3 ± 14.8 days; P = .012), and required longer pleural drainage (106 ± 45 hours vs 104 ± 93 hours; P = .046). Hospital survival was 100% in both groups. Actuarial survival to 12 months was 96% ± 4% for group I and 96% ± 3% for group II.

CONCLUSIONS: Early cavopulmonary anastomosis after the Norwood operation is safe. Younger patients are more cyanotic initially after surgery and have a longer duration of mechanical ventilation, pleural drainage, intensive care unit stay, and hospitalization.




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