Bidirectional cavapulmonary anastomosis as a stage of haemodynamic correction of left heart hypoplasia syndrome

Abstract

Objective. To retrospectively analyse the perioperative characteristics of patients with left heart hypoplasia syndrome, to assess immediate and long-term results after bi-directional cavapulmonary anastomosis. Materials and methods. During the period from 2010 to 2023, the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine performed a bidirectional cavapulmonary anastomosis in 8 patients with left heart hypoplasia syndrome: 7 boys and 1 girl. The median age of patients at the time of the intervention was 8 months. The main research methods were transthoracic echocardiography and cardiac catheterisation. Results. No patient died in the early postoperative period. In 2 patients, before the bidirectional cavapulmonary anastomosis, there was high pressure in the pulmonary artery system due to the presence of hemodynamically significant collateral vessels that were endovascularly closed before the intervention. All patients underwent the second stage of haemodynamic correction in the form of a bidirectional cavapulmonary anastomosis. The average duration of the operation was 480 minutes, and the artificial circulation was 117 minutes. The median transpulmonary gradient at the intraoperative stage was 6 mm Hg, in the postoperative period - 7 mm Hg. The pressure in the superior vena cava system and blood saturation after the second stage of hemodynamic correction were 15 mm Hg and 84%, respectively. Sympathomimetic support lasted 48 hours, and the total length of stay in the intensive care unit was 168 hours. The third stage of haemodynamic correction was performed in 4 patients. Conclusions.  Bidirectional cavapulmonary anastomosis in patients with left heart hypoplasia syndrome provides better pulmonary circulation, which contributes to increased blood saturation, eliminates volume overload of the right ventricle, reducing venous return to it, and delays the development of heart failure. It is important to perform each stage of haemodynamic correction in a timely manner, which affects early and long-term results, the severity of preoperative and postoperative haemodynamics, interstage survival rates and postoperative complications.