Abstract 19002: Predictive Value of the Intraoperative Pulmonary Artery Flow Study for Early and Late Outcome After Surgical Treatment of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries (MAPCAs)
Introduction & Hypothesis: 1. To evaluate the accuracy of the intraoperative pulmonary artery (PA) flow study in determining the feasibility of concomitant VSD closure after complete one-stage unifocalization in patients with pulmonary atresia with VSD and MAPCAs. 2. To determine the ability of the PA flow study to predict long-term outcomes.
Methods: Between October 1996 and May 2015, a PA flow study was obtained in 92 patients undergoing complete one-stage unifocalization. The study was performed by cannulating the unifocalized central PA. With the heart beating, incremental volumes of blood were pumped through the PAs. The ability to achieve 100% flow (2.5 l/min/m2) into the pulmonary bed at a mean pressure (mPAP) ≤ 30 mmHg was used as an indicator for acceptability of VSD closure.
Results: Among the 92 patients who had a PA flow study, 23 had a mPAP > 30 mmHg and the VSD was left open. VSD closure was performed in 69 patients (mPAP 24 ± 5 mmHg, range 11-34 mmHg). However, four (5.8%) required patch fenestration due to suprasystemic RV pressure. The recorded mPAPs of these 4 patients were 29, 24, 22 and 28 mmHg, respectively. In the whole cohort, median weight at operation was 7.9 kg (range, 2.5-54 kg). The PA flow study accurately predicted successful VSD closure (area under the curve 0.852, Figure 1A). VSD closure at the time of unifocalization resulted in a clear survival advantage (p = 0.0363). mPAP correlated with RVP to LVP ratio (rho 0.460, p = 0.0001) and better long-term results were observed with intraoperative mPAP ≤ 30 mmHg (p = 0.24, Figure 1B).
Conclusions: Successful VSD closure in patients with MAPCAs can be reliably defined by an intraoperative PA flow study with a cut-off of 30 mmHg. The PA flow study predictive value is particularly useful to select patients in which the VSD should be left open. mPAP strongly correlates with the intraoperative RVP/LVP ratio and lower values of mPAP at the time of the unifocalization are associated with improved long-term outcomes.
- intraoperative pulmonary artery flow-study
- Pulmonary atresia
- ventricular septal defect
- Major aorto-pulmonary collaterals
Author Disclosures: M. Trezzi: None. A. Albano: None. S. Albanese: None. E. Cetrano: None. A. Carotti: None.
- © 2015 by American Heart Association, Inc.