Bidirectional superior cavopulmonary connection in young infants

Abstract

Background: Bidirectional superior cavopulmonary connection (BSCC) has become widely used in patients with univentricular AV connections. However, concerns remain about perioperative morbidity and mortality and about the adequacy of oxygenation after cavopulmonary connection in very young patients. This report examines our experience with BSCC in young infants to evaluate whether young age affects operative outcome, to examine the effect of young age on postoperative oxygenation, and to define the lower age limit for successful use of the procedure.

Methods and results: The records of the 85 consecutive patients < 6.5 months old who underwent BSCC from December 1990 through February 1995 were reviewed. The average patient age was 4.8 +/- 1.4 months (range, 5 weeks to 6.5 months), with 13 patients being < 3 months old. There were 5 hospital deaths (6%; 70% confidence limits, 3% to 10%). Pulmonary artery thrombosis occurred in 3 patients (4%; 70% confidence limits, 2% to 7%). Younger age was significantly associated with pulmonary artery thrombosis but not with operative death. Oxygenation (arterial PO2, and oxygen saturation) improved significantly and spontaneously over the first 48 hours after BSCC. Younger age had a significant adverse effect on oxygenation in the early postoperative period (first 48 hours).

Conclusions: BSCC can be performed successfully in infants < 6 months old and as young as 5 weeks old. Within this patient population, younger age is not associated with perioperative death but is associated with pulmonary artery thrombosis and postoperative hypoxemia. We suggest that BSCC may be performed any time beyond the neonatal period in symptomatic patients and may be delayed until 4 to 6 months of age if completely elective.