Low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure

Shuhua Luo; Maruti Haranal; Mimi Xiaoming Deng; Jaymie Varenbut; Kyle Runeckles; Chun-Po Steve Fan; Mike Seed; Glen S Van Arsdell; Osami Honjo

doi:10.1016/j.jtcvs.2020.04.098

Low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure

J Thorac Cardiovasc Surg. 2020 Dec;160(6):1529-1540.e4. doi: 10.1016/j.jtcvs.2020.04.098. Epub 2020 May 5.

Authors

Shuhua Luo¹, Maruti Haranal², Mimi Xiaoming Deng², Jaymie Varenbut², Kyle Runeckles³, Chun-Po Steve Fan³, Mike Seed⁴, Glen S Van Arsdell⁵, Osami Honjo⁶

Affiliations

¹ Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
² Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
³ Ted Rogers Computational Program, Cardiovascular Data Management Centre, Ted Rogers Centre for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada.
⁴ Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁵ Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; UCLA Mattel Children's Hospital, Los Angeles, Calif.
⁶ Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: osami.honjo@sickkids.ca.

PMID: 32595030
DOI: 10.1016/j.jtcvs.2020.04.098

Abstract

Background: In this study we sought to determine whether preoperative superior vena cava (SVC) blood flow measured using cardiac magnetic resonance (CMR) predicts physiology and clinical outcome after bidirectional cavopulmonary shunt (BCPS).

Methods: The retrospective single-center study included 65 (2012-2017) patients who underwent BCPS. Preoperative CMR imaging, echocardiography, catheterization, and clinical outcomes were reviewed. SVC flow was measured using phase contrast CMR. The Kaplan-Meier method and Cox regression was used for BCPS takedown-free survival and predictor analyses.

Results: The absolute and indexed SVC flow was 0.5 (interquartile range [IQR], 0.4-0.7) L/min and 1.7 (IQR, 1.4-2.0) L/min/mm² respectively, which was comparable with the SVC blood flow volume previously measured. The median age and body weight at BCPS was 6.5 (IQR, 5.5-8.5) months and 6.9 (IQR, 6.0-7.7) kg. After follow-up, at a median of 17.1 (IQR, 7.9-41.3) months, 14 patients (21.5%) underwent the Fontan completion and 40 (61.5%) with BCPS physiology were waiting for the Fontan completion. The 11 remaining patients (16.9%), included those who underwent takedown (n = 7; 10.8%) or died with a BCPS (n = 4; 6.2%). Severe hypoxia was the leading cause of mortality, directly accounting for two-thirds of deaths (66.6%; 6/9). The BCPS takedown-free survival was 96.8% at 6 months, and 79.9% at 3 years. Preoperative SVC blood flow was significantly positively correlated with early post-BCPS arterial saturation (P = .00). The multivariable analysis showed SVC flow was the only factor associated with BCPS failure (hazard ratio, 0.186; P = .04) among the predictors related to the pre-BCPS anatomy and physiology.

Conclusions: SVC blood flow might be as critically important as pulmonary artery anatomic and physiologic parameters in the evaluation of BCPS candidacy in the single-ventricle population.

Keywords: bidirectional cavopulmonary shunt; cardiac magnetic resonance imaging; superior vena cava; takedown.

MeSH terms

Blood Flow Velocity / physiology*
Echocardiography
Female
Follow-Up Studies
Fontan Procedure / adverse effects*
Heart Defects, Congenital / diagnosis
Heart Defects, Congenital / physiopathology
Heart Defects, Congenital / surgery*
Humans
Infant
Male
Predictive Value of Tests
Retrospective Studies
Treatment Failure
Vena Cava, Superior / diagnostic imaging
Vena Cava, Superior / physiopathology*
Vena Cava, Superior / surgery