title: Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion.
abstract: OBJECTIVE
  The bi-directional cavopulmonary anastomosis forms an essential staging procedure for univentricular hearts. This review aims to identify risk factors for morbidity, mortality, and suitability for Fontan completion.
  
  
  METHODS
  A total of 114 patients undergoing cavopulmonary anastomosis between 1992 and 2012 were reviewed to assess primary - mortality and survival to Fontan completion - and secondary outcome endpoints - re-intubation, new drain, and ICU stay. Median age and weight were 8 months and 6.9 kg, respectively. In 83% of patients, 1-3 interventions had preceded. Norwood-type procedures became more prevalent over time.
  
  
  RESULTS
  Extubation occurred after a median of 4 hours, median ICU stay was 2 days; 10 patients (8.8%) needed re-intubation and 18 received a new drain. Higher central venous pressure and transpulmonary gradient were risk factors for new drain insertion (p<0.01). Higher pre-operative pulmonary pressure correlated with increased inotropic support and prolonged intubation (p=0.01). Need for re-intubation was significantly affected by younger age at operation (p=0.01). Hospital and pre-Fontan mortality were 11.4 and 5.3%, respectively. Operative mortality was independently affected by younger age (p=0.013), lower weight (p=0.02), longer bypass time (p=0.04), and re-intubation (p=0.004). Interstage mortality was mainly influenced by moderate ventricular function (p=0.03); 82% of survivors underwent or are candidates for Fontan completion.
  
  
  CONCLUSIONS
  The cavopulmonary anastomosis remains associated with adverse outcomes. Age at operation decreases with rising prevalence of complex univentricular hearts. Considering the important impact of re-intubation on hospital mortality, peri-operative management should focus on optimising cardio-respiratory status. Once this selection step is taken, successful Fontan completion can be expected, provided that ventricular function is maintained.
authors.affiliation: 1Department of Congenital Cardiac Surgery,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: François
authors.affiliation: 2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Kristof
authors.initials: K
authors.lastname: Vandekerckhove
authors.affiliation: 2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Katya
authors.initials: K
authors.lastname: De Groote
authors.affiliation: 2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Joseph
authors.initials: J
authors.lastname: Panzer
authors.affiliation: 2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: De Wolf
authors.affiliation: 2Department of Pediatric Cardiology,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Hans
authors.initials: H
authors.lastname: De Wilde
authors.affiliation: 1Department of Congenital Cardiac Surgery,The Cardiac Centre,University Hospital Gent,Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bové
mesh_terms: D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods* / Q000401:mortality; D018610:Heart Bypass, Right / Q000379:methods* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Congenital heart disease; paediatric cardiac surgery; post-operative management; single ventricle