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J Thorac Cardiovasc Surg 2007;134:82-89
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Survival after bidirectional cavopulmonary anastomosis: Analysis of preoperative risk factors

Mark A. Scheurer, MDa,*, Elizabeth G. Hill, PhDd, Nagavardhan Vasuki, MDb, Scott Maurer, MDc, Eric M. Graham, MDe, Varsha Bandisode, MDe, Girish S. Shirali, MBBSe, Andrew M. Atz, MDe, Scott M. Bradley, MDf

a Department of Cardiology, Children’s Hospital Boston, Boston, Mass
b Department of Medicine, Emory University, Atlanta, Ga
c Department of Pediatrics, Naval Medical Center, San Diego, Calif
d Department of Biostatistics, Bioinformatics & Epidemiology, Medical University of South Carolina, Charleston, SC
e Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, SC
f Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.

Received for publication December 21, 2006; revisions received January 12, 2007; accepted for publication February 5, 2007.

* Address for reprints: Mark A. Scheurer, MD, Instructor of Pediatrics, Harvard Medical School, Cardiac Intensivist, Department of Cardiology, Children’s Hospital Boston, Bader 660, 300 Longwood Ave, Boston, MA 02115. (Email: mark.scheurer{at}cardio.chboston.org).

Objective: Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis.

Methods: Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or transplanted) were assessed with Wilcoxon rank sum test and {chi}2 or Fisher exact tests. Survival functions were constructed with Kaplan–Meier estimates, and event times compared between subgroups with log–rank tests. Cox proportional hazard modeling was used for multivariable modeling of risk of death or transplantation.

Results: One hundred sixty-seven patients underwent bidirectional cavopulmonary anastomosis with hemi-Fontan (n = 62) or bidirectional Glenn (n = 105) operations. Three patients died before discharge, 11 died later, and 1 has undergone transplantation. Freedom from death or transplantation after bidirectional cavopulmonary anastomosis was 96% at 1 year and 89% at 5 years. Multivariable analysis of preoperative variables showed atrioventricular valve regurgitation to be an independent risk factor for death or transplantation (hazard ratio 2.8, 95% confidence interval 1.1–7.1, P = .02).

Conclusion: Although survival after bidirectional cavopulmonary anastomosis is high, preoperative atrioventricular valve regurgitation is an important risk factor for death or transplantation.

Abbreviations and Acronyms BCPA = bidirectional cavopulmonary anastomosis; HLHS = hypoplastic left heart syndrome




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