title: Surgical outcome of staged univentricular-type repairs for patients with univentricular physiology and pulmonary hypertension.
abstract: BACKGROUND
  There is no consensus about the most appropriate limits of pulmonary artery pressure and vascular resistance in case of patients undergoing univentricular or one and one-half ventricular repair. This study was conducted to analyze the mortality and morbidity of a heterogenous group of patients with a functionally univentricular heart and pulmonary artery hypertension, undergoing pulmonary artery banding followed by univentricular-type repairs.
  
  
  RESULTS
  Out of 254 patients undergoing pulmonary artery banding for a functionally univentricular heart with increased pulmonary blood flow, 148 patients underwent definitive second stage surgery. Post-band hemodynamic evaluation revealed persistently high pulmonary artery pressure (> 18 mmHg), and pulmonary vascular resistance (>2.0 Woods units/m2) in 78.3% patients. Sixteen patients with moderate right ventricular hypoplasia were given a one and one-half ventricle repair (Group I), 82 patients a bidirectional Glenn connection (Group II), and 50 patients a fenestrated total cavopulmonary connection (Group III). The overall mortality following second stage surgery for the high pulmonary artery pressure group (n=116) was 30.17%, while none of the low pulmonary artery pressure group died (p=0.0009). Pulmonary hypertensive crises and/or systemic desaturation were the main causes of death at second stage repair. All mortality occurred in patients with mean pulmonary artery pressure > 18 mmHg and pulmonary vascular resistance > 3.5 Woods units/m2. Survivors from this group had persistent morbidity in the form of superior vena caval syndrome and suboptimal oxygen saturation (70-75%).
  
  
  CONCLUSIONS
  It is advisable not to proceed with definitive second stage repair if post-pulmonary artery banding mean pulmonary artery pressure is over 25 mmHg and pulmonary vascular resistance exceeds 4.0 Woods units/m2. These patients may possibly be deemed to have undergone definitive palliation during their pulmonary artery banding.
authors.affiliation: Departments of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi. ujjwalchow@rediffmail.com
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Kothari
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sharma
authors.forename: Ganapathy K
authors.initials: GK
authors.lastname: Subramaniam
authors.forename: Anil
authors.initials: A
authors.lastname: Bhan
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.forename: Panangipalli
authors.initials: P
authors.lastname: Venugopal
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality; D002675:Child, Preschool; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000601:surgery; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D016896:Treatment Outcome