Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Background. The impact of additional pulmonary forward flow (APF) through the pulmonary valve at the time of bidirectional cavopulmonary shunt (BCPS) is unknown. Methods. Between 2000 and 2010, 276 patients had BCPS and 126 of them were selected, including 60 patients with APF via pulmonary valve and 66 patients, in whom the pulmonary valve was closed. We compared the length of hospital stay and duration of pleural drainage at BCPS and Fontan operations. We also compared the number of surgical interventions before BCPS, the number of operations between BCPS and Fontan operation, Nakata index prior to Fontan operation, grade of atrioventricular valve regurgitation (AVVR), and oxygen saturations prior to Fontan operation. Results. Prior to BCPS, 20% (12 of 60) of patients with APF and none without APF had pulmonary artery (PA) banding. More patients without APF had systemic-to-PA shunts (p < 0.01). Fontan operation was completed in 58% (35 of 60) of patients with APF and in 68% (45 of 66) of patients without APF (p = 0.34). There was no difference in the length of hospital stay or duration of pleural drainage at BCPS. No significant difference was observed in the number of surgical procedures between BCPS and Fontan operation, grade of AVVR or oxygen saturations before Fontan operation. Children with APF had a higher Nakata index (p= 0.02) prior to Fontan operation, shorter duration of pleural drainage (p = 0.009) and shorter hospital stay (p = 0.009) after Fontan operation. Conclusions. Children with APF at BCPS had better developed PAs, shorter duration of pleural drainage, and shorter hospital stay after Fontan operation. (C) 2015 by The Society of Thoracic Surgeons