title: The effect of additional pulmonary blood flow on timing of the total cavopulmonary connection.
abstract: BACKGROUND
  The staged Fontan procedure is used to palliate functionally univentricular hearts. The effect of additional pulmonary blood flow combined with a bidirectional cavopulmonary shunt in these patients remains a controversial subject.
  
  
  METHODS
  This retrospective study included all 82 patients with a unilateral or bilateral bidirectional cavopulmonary shunt at our institution between April 1990 and July 2010. Patients with hypoplastic left heart syndrome were excluded. Two groups, based on the presence (n=57) or absence (n=25) of additional pulmonary blood flow after the bidirectional cavopulmonary shunt, were compared.
  
  
  RESULTS
  Patients with a bidirectional cavopulmonary shunt combined with additional pulmonary blood flow had higher arterial oxygen saturations postoperatively (86% [interquartile range, 85% to 90%] vs 82% [80% to 85%]; p=0.001) and had a longer median interval before the total cavopulmonary connection (3.42 [2.43 to 4.89] years vs 2.90 [2.08 to 3.32] years; p=0.06). At the total cavopulmonary connection, they were older (4.59 [3.88 to 6.49] years vs 3.94 [3.10 to 4.57] years; p=0.03) and had a larger median body surface area (0.73 [0.65 to 0.87] m2 vs 0.68 [0.59 to 0.73] m2; p=0.04).
  
  
  CONCLUSIONS
  Patients with a bidirectional cavopulmonary shunt and additional pulmonary blood flow have a longer interval before the total cavopulmonary connection without evident untoward effects. This may theoretically be advantageous for the pulmonary artery growth needed for a successful Fontan circulation. Furthermore, postponement of the final Fontan may ensure the insertion of a larger extracardiac conduit to avoid prosthesis-patient mismatch.
authors.affiliation: Department of Cardiothoracic Surgery, Center for Congenital Heart Diseases, University Medical Center Groningen, Groningen, the Netherlands. y.j.van.slooten@umcg.nl
authors.forename: Ymkje J
authors.initials: YJ
authors.lastname: van Slooten
authors.forename: Nynke J
authors.initials: NJ
authors.lastname: Elzenga
authors.forename: Tjalling W
authors.initials: TW
authors.lastname: Waterbolk
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.forename: Rolf M F
authors.initials: RM
authors.lastname: Berger
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
mesh_terms: D000367:Age Factors; D001783:Blood Flow Velocity / Q000502:physiology*; D001810:Blood Volume / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000098:blood supply*; D008297:Male; D010100:Oxygen / Q000097:blood; D010166:Palliative Care; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D010100:Oxygen