Survival after bidirectional cavopulmonary anastomosis: analysis of preoperative risk factors.
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 chi2 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).


CONCLUSIONS
Although survival after bidirectional cavopulmonary anastomosis is high, preoperative atrioventricular valve regurgitation is an important risk factor for death or transplantation.
Scheurer
Mark A
MA
Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA. mark.scheurer@cardio.chboston.org
Hill
Elizabeth G
EG
Vasuki
Nagavardhan
N
Maurer
Scott
S
Graham
Eric M
EM
Bandisode
Varsha
V
Shirali
Girish S
GS
Atz
Andrew M
AM
Bradley
Scott M
SM
D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D018610:Heart Bypass, Right / Q000401:mortality*; D006349:Heart Valve Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D008955:Models, Cardiovascular; D015233:Models, Statistical; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome