Journal Article

Surgical approach for systemic-pulmonary shunt in neonates with functionally univentricular heart: comparison between sternotomy and thoracotomy

Takeda, Yuko, Sasaki, Takashi, Ohnakatomi, Yasuko, Asou, Toshihide

2016

Overview

Objective The preferred surgical approach for systemic-pulmonary shunts has changed from thoracotomy to sternotomy in our institution, to concomitantly manage the ductus arteriosus during surgery. The purpose of this study was to compare the outcomes of systemic-pulmonary shunts for neonates with functionally univentricular hearts based on surgical approach. Methods Fifty-two neonates with functionally univentricular hearts underwent systemic-pulmonary shunt via sternotomy ( n  = 28) or thoracotomy ( n  = 24). Patient characteristics, achievement rates of right heart bypass, and survival rates were compared for the different approaches. Results Prenatal diagnosis was made more common in the sternotomy group ( p  = 0.006). The shunt was placed more centrally in the sternotomy group. The ductus arteriosus was ligated or banded in most patients in the sternotomy group (26/28) and in a few patients in the thoracotomy group (6/24). Frequency of ductal management in the early postoperative phase was not different between the groups (21 vs 25 %), but three new incisions had to be made in the thoracotomy group. No differences were seen in the achievement rates of bidirectional cavopulmonary shunts (86 vs 87 % at 10 months of age) and total cavopulmonary connection (81 vs 81 % at 2 years of age), or in the survival rates (92 vs 96 % at 8 years). Conclusions There were no differences in short- and long-term outcomes between the groups. The sternotomy approach might be preferable in the current era of prenatal diagnosis, to allow simultaneous duct management during systemic-pulmonary shunt surgery, particularly in patients with large ducts associated with functionally univentricular hearts.

• Publisher: Springer Japan,Springer Nature B.V
• Subject: Anticoagulants / Cardiac Surgery / Cardiology / Cardiovascular disease / Congenital diseases / Ductus Arteriosus - surgery / Ductus Arteriosus, Patent - surgery / Female / Fontan Procedure - methods / Heart / Heart Ventricles - abnormalities / Heart Ventricles - surgery / Humans / Infant, Newborn / Male / Medicine / Medicine & Public Health / Original Article / Ostomy / Patients / Pulmonary arteries / Pulmonary Artery - surgery / Retrospective Studies / Sternotomy - methods / Surgery / Surgical Oncology / Survival Rate / Thoracic Surgery / Thoracotomy - methods / Veins & arteries