Bidirectional Cavopulmonary Shunt for Cyanotic Heart Disease: Surgical Experience from a Developing Country

Objective: The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. This study was conducted to highlight our surgical experience with this procedure in a developing country. Methods: A retrospective study was conducted using medical records at the Aga Khan University Hospital, Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography, pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia, post-procedure oxygen saturations and complications were evaluated. Results: A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males (75%) and 2 females (25%). Ages and weights at operation averaged 5.7 ± 3.7 years (range 2-14 years) and 18.6 ± 10.4 kg (range 8.5-35.5 kg) respectively. The most common symptoms were the presence of cyanosis in all (100%) patients followed by recurrent respiratory tract infections in 3 (37.5%) patients. Transthoracic echocardiography revealed 6 (75%) patients with atrial septal defects, 5 (62.5%) with tricuspid atresia, 3 (37.5%) with ventricular septal defects, 3 (37.5%) with malposition of great vessels, 2 (25%) with pulmonary stenosis and 2 (25%) with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 ± 0.5 (range 1.37-2.80). All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 ± 83.6 minutes (range 60-298 minutes). All patients were ventilated for a mean period of 1.5 ± 0.7 days (range 1-3 days). The ICU stay was 3.0 ± 0.6 days (range 2-5 days) with a total hospital stay of 9.8 ± 3.8 days (range 7-18 days). The mean post-procedure oxygen saturation was 82.6 ± 3.5% (range 76-86%). The most common post-operative complication was supraventricular arrhythmia in 2 (25.0%) patients. There were no intraoperative or early (within 7 days of procedure) deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Conclusion: Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association (NYHA) functional class I and one patient in NYHA class II. Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopulmonary anastomosis.