Abstract 18211: Can Salvage Takedown of Cavopulmonary Connection Act as a Bridge to Subsequent Palliation?
Objectives: Bidirectional cavopulmonary shunt (BCPS) and Fontan takedown are needed occasionally in failing single-ventricle palliation. We sought to analyze the outcomes of salvage takedown focusing on physiologic tolerance and subsequent clinical outcomes.
Methods: Twenty-four patients who underwent BCPS or Fontan takedown procedures from 1986 to 2013 were reviewed. Physiologic tolerance was defined as bridge to subsequent re-BCPS or re-Fontan, transplantation, and palliation suitable for future transplantation. Outcomes were compared using competing risk and Kaplan-Meier analysis.
Results: Nine (38%) patients underwent BCPS takedown [8 (89%) after 2000] and 15 (62%) patients underwent Fontan takedown [2 (13%) after 2000]. Nineteen (79%) patients had acute takedown (<1 month). The indications for BCPS takedown included hypoxia (n=7) and superior vena cava syndrome (n=2). Fontan takedown was due to low cardiac output (n=7), high Fontan pressure (n=5), cyanosis (n=1), persistent drainage (n=1), and protein losing enteropathy (n=1). Post-BCPS takedown physiology included 6 aortopulmonary shunt (APS) and 3 BCPS + APS, while post-Fontan takedown physiology included 12 BCPS + APS, 2 APS, and one 1.5 ventricle repair. The oxygen saturations at two weeks after BCPS takedown were significantly higher than before takedown (71.3±2.8% vs 41.7±14.6%, p=0.004). There were 10 (42%) in-hospital deaths and 3 (13%) late deaths. Overall, 11 (46%) patients were salvaged [3 (13%) re-BCPS/re-Fontan, 4 (17%) heart transplantation, 4 (17%) palliations suitable for later transplantation, Figure 1A]. All survivors were in NYHA class I-II except one who had failing BCPS+APS physiology. There was no significant difference in survival between BCPS and Fontan takedown (p=0.939, Figure 1B).
Conclusions: Cavopulmonary connection takedown procedures salvaged nearly half of patients despite substantial early mortality. The functional status of survivors is reasonable.
Author Disclosures: J. Zhu: None. D. Chetan: None. A. Saedi: None. J.G. Coles: None. C.A. Caldarone: None. G.S. Van Arsdell: None. O. Honjo: None.
- © 2014 by American Heart Association, Inc.