Staged surgical repair for single ventricle with systemic outflow tract obstruction

  • Shinichiro Oda, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
  • Toshihide Nakano, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
  • Kazuhiro Hinokiyama, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
  • Takahisa Sakurai, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
  • Kunihiko Joo, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
  • Hideaki Kado, Department of cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan

    • Objectives: We review our experience with initial pulmonary artery banding (PAB) followed by a Damus-Kaye-Stansel procedure with bidirectional Glenn (BDG) in the subset of patients with functional single ventricles (SV) and systemic outflow tract obstructions (SOTO) to determine if this staged operative strategy influences the outcome of Fontan completion.
    Methods: Between January 1990 and October 2008, 27 patients with functional SV with SOTO were included. Our criteria for initial PAB in these patients are over 1 mm plus body weight in diameter of SOTO. Seventeen patients had concomitant aortic coarctation or interrupted aortic arch repair (63%).
    Results: The overall mortality was 11% (three of 27 patients) with a mean follow up period of 7.5 ± 1.0 years (range, 3 months to 18 years). Significant development of SOTO was recognized in 2 patients (7%) after an initial PAB. The other patient’s average pressure gradient across SOTO before DKS+BDG procedure was 6.7 ± 1.5 mmHg. Twenty-five patients (25/27, 93%) have undergone DKS + BDG procedure. Twenty patients (20/27, 74%) have undergone the completion Fontan procedure and 4 patients are awaiting the next stage. Cardiac catheterization data (CVP 9.7 ± 0.5mmHg, EDP 4.2 ± 0.6mmHg, SaO2 94.7 ± 0.2%) and cardiorespiratory response to exercise data (peak VO2: 92.5 ± 7.4% of normal) after Fontan completion revealed sufficient results of this approach.
    Conclusion: In patients with subpopulation of functional SV with SOTO, an initial PAB coupled with planned DKS + BDG procedure can be an acceptable operative strategy.