Introduction
Methods
Patient Selection
Surgical Techniques and Perioperative Management
Follow-Up Surveillance
Pre-TCPC Flow Dynamics and Bilateral BCPS Pathway Dimensions
Statistical Analysis
Results
Patient Characteristics
Variables | Bilateral BCPS | Unilateral BCPS | p value |
---|---|---|---|
n (%) | n (%) | ||
Number of patients | 40 (9.9) | 365 (90.1) | |
Primary diagnosis | |||
HLHS | 5 (12.5) | 118 (32.3) | 0.010 |
Univentricular heart | 26 (65.0) | 72 (19.7) | < 0.001 |
TA | 0 (0.0) | 63 (17.3) | 0.004 |
DILV | 2 (5.0) | 48 (13.2) | 0.137 |
PAIVS | 0 (0.0) | 19 (5.2) | 0.139 |
ccTGA | 0 (0.0) | 17 (4.7) | 0.163 |
Unbalanced AVSD | 2 (5.0) | 11 (3.0) | 0.499 |
Other | 5 (12.5) | 17 (4.7) | 0.038 |
Associated cardiac anomaly | |||
TGA | 18 (45.0) | 122 (33.4) | 0.144 |
DORV | 14 (35.0) | 41 (11.2) | < 0.001 |
CoA | 5 (12.5) | 54 (14.8) | 0.696 |
Dextrocardia | 13 (32.5) | 21 (5.8) | < 0.001 |
Heterotaxy | 16 (40.0) | 13 (3.6) | < 0.001 |
Azygos continuation | 7 (17.5) | 3 (0.8) | < 0.001 |
TAPVC/PAPVC | 8 (20.0) | 17 (4.7) | < 0.001 |
CAVV | 17 (42.5) | 22 (6.0) | < 0.001 |
Dominant RV | 35 (87.5) | 200 (54.8) | < 0.001 |
Extra-cardiac anomaly | 9 (23.1) | 34 (9.9) | 0.013 |
Genetic anomaly | 2 (5.1) | 10 (2.9) | 0.448 |
Variables n (%), median (IQR), or mean ± SD | Bilateral BCPS | Unilateral BCPS | p value |
---|---|---|---|
Number of patients | 40 (9.9) | 365 (90.1) | |
Age at BCPS (years) | 0.6 (0.4–1.5) | 0.4 (0.3–0.8) | 0.156 |
Weight at BCPS (kg) | 6.5 (5.0–8.2) | 5.8 (4.9–7.4) | 0.337 |
Height at BCPS (cm) | 69 (61–78) | 64 (60–70) | 0.056 |
Pre-BCPS catheterization data | |||
Hemoglobin level | 14.7 ± 2.2 | 14.2 ± 2.0 | 0.186 |
Pulmonary artery pressure | 14.7 ± 4.6 | 14.8 ± 4.8 | 0.913 |
Left atrial pressure | 6.2 ± 2.7 | 6.2 ± 2.7 | 0.949 |
Transpulmonary gradient (TPG) | 8.3 ± 3.7 | 8.5 ± 4.3 | 0.863 |
Systemic ventricular pressure | 78.1 ± 11.4 | 79.9 ± 12.6 | 0.418 |
End-diastolic pressure (EDP) | 7.9 ± 2.9 | 8.6 ± 3.1 | 0.210 |
Systolic aortic pressure | 76.6 ± 11.0 | 78.0 ± 12.7 | 0.534 |
Mean aortic pressure (MAP) | 53.2 ± 8.1 | 50.9 ± 8.4 | 0.129 |
Aortic oxygen saturation (SO2) | 78.3 ± 7.1 | 75.3 ± 7.7 | 0.032 |
Operative data | |||
CPB time (min) | 92 (68–113) | 61 (45–85) | < 0.001 |
Aortic cross-clamp | 5 (12.5) | 77 (22.1) | 0.158 |
Concomitant procedure | |||
DKS | 1 (2.5) | 3 (0.8) | 0.308 |
AVV procedure | 1 (2.5) | 41 (11.2) | 0.085 |
Aorta patch plasty | 1 (2.5) | 10 (2.7) | 0.929 |
PA reconstruction | 13 (32.5) | 143 (39.2) | 0.410 |
SVOT enlargement | 0 (0.0) | 6 (1.6) | 0.414 |
Post-TCPC Outcomes
Flow Dynamics and Bilateral BCPS Pathway Dimensions
Variables Mean ± SD | Concordant relationship | Discordant relationship | p value |
---|---|---|---|
Number of patients | 30 | 10 |
Right | Left | Right | Left | ||
---|---|---|---|---|---|
Dominant SVC | 21 | 9 | 1 | 9 | |
IVC/HV to PA connection | 21 | 9 | 9 | 1 | |
Central PA diameter | 7.2 ± 3.5 | 6.3 ± 2.1 | 0.431 | ||
Right PA diameter | 10.3 ± 2.4 | 9.7 ± 2.7 | 0.532 | ||
Left PA diameter | 9.5 ± 2.0 | 10.0 ± 3.7 | 0.728 | ||
Distance from right/left SVCs | 17.5 ± 5.7 | 23.4 ± 12.8 | 0.057 | ||
Dominant SVC diameter | 8.9 ± 1.7 | 10.8 ± 3.2 | 0.090 | ||
Non-dominant SVC diameter | 8.8 ± 2.3 | 7.8 ± 1.3 | 0.192 | ||
Dominant/non-dominant SVC ratio | 1.1 ± 0.3 | 1.4 ± 0.3 | 0.012 |
Impact of a Discordant Relationship Between the Dominant SVC and the IVC on Post-TCPC Outcomes
Variables | Univariate model | Multivariate model | ||||
---|---|---|---|---|---|---|
p value | HR | 95% CI | p value | HR | 95% CI | |
Morphological factors | ||||||
DORV | 0.278 | 0.692 | 0.355–1.348 | |||
Dextrocardia | 0.579 | 0.822 | 0.413–1.639 | |||
Heterotaxy | 0.485 | 1.263 | 0.656–2.427 | |||
Azygos continuation | 0.175 | 1.842 | 0.763–4.444 | |||
TAPVD/PAPVD | 0.269 | 1.597 | 0.696–3.676 | |||
CAVV | 0.671 | 1.147 | 0.609–2.160 | |||
Dominant RV | 0.401 | 1.513 | 0.576–3.984 | |||
Hemodynamic factors | ||||||
PAP | 0.580 | 10.28 | 0.933–1.133 | |||
LAP | 0.926 | 1.005 | 0.897–1.126 | |||
SVP | 0.899 | 1.002 | 0.975–1.030 | |||
EDP | 0.920 | 1.006 | 0.890–1.138 | |||
AVVR pre-TCPC | 0.061 | 2.331 | 0.961–5.650 | 0.050 | 1.044 | 1.001–6.024 |
APC | 0.217 | 1.587 | 0.763–3.300 | |||
Pre-TCPC data | ||||||
Age at TCPC | 0.097 | 1.106 | 0.982–1.245 | |||
CPB time | 0.113 | 1.006 | 0.999–1.013 | |||
Aortic cross-clamp | 0.137 | 1.642 | 0.854–3.155 | |||
Aortic cross-clamp time | 0.073 | 1.019 | 0.998–1.041 | |||
BCPS pathway size | ||||||
Small central PA | 0.198 | 1.592 | 0.784–3.226 | |||
Diameter of right SVC | 0.900 | 1.011 | 0.853–1.199 | |||
Diameter of left SVC | 0.220 | 1.075 | 0.958–1.206 | |||
Diameter of right PA | 0.757 | 0987 | 0.850–1.125 | |||
Diameter of left PA | 0.593 | 1.090 | 0.924–1.148 | |||
Diameter of central PA | 0.219 | 0.936 | 0.843–1.040 | |||
Distance between SVCs | 0.077 | 1.044 | 0.995–1.094 | |||
TCPC conduit diameter | 0.450 | 0.874 | 0.616–1.241 | |||
BCPS flow dynamics | ||||||
Right dominant SVC (right to left) | 0.405 | 0.758 | 0.395–1.456 | |||
Left dominant SVC (left to right) | 0.405 | 1.319 | 0.687–2.533 | |||
Discordant relationship between dominant SVC and IVC | 0.043 | 2.288 | 1.028–5.102 | 0.037 | 2.370 | 1.052–5.348 |
Variables | Univariate model | Multivariate model | ||||
---|---|---|---|---|---|---|
p value | HR | 95% CI | p value | HR | 95% CI | |
Morphological factors | ||||||
DORV | 0.485 | 0.457 | 0.051–4.103 | |||
Dextrocardia | 0.560 | 0.520 | 0.058–4.672 | |||
Heterotaxy | 0.966 | 0.962 | 0.160–5.777 | |||
Azygos continuation | 0.268 | 2.751 | 0.459–16.487 | |||
TAPVD/PAPVD | 0.220 | 3.091 | 0.509–18.794 | |||
CAVV | 0.577 | 0.601 | 0.100–3.600 | |||
Dominant RV | 0.426 | 0.407 | 0.045–3.716 | |||
Hemodynamic factors | ||||||
PAP | 0.052 | 1.201 | 0.998–1.445 | |||
LAP | 0.629 | 1.063 | 0.830–1.362 | |||
SVP | 0.614 | 1.017 | 0.952–1.087 | |||
EDP | 0.873 | 1.026 | 0.749–1.406 | |||
AVVR pre-TCPC | 0.887 | 1.172 | 0.131–10.508 | |||
APC | 0.910 | 0.881 | 0.098–7.900 | |||
Pre-TCPC data | ||||||
Age at TCPC | 0.013 | 1.206 | 1.041–1.397 | |||
CPB time | 0.163 | 1.014 | 0.994–1.033 | |||
Aortic cross-clamp | 0.373 | 2.257 | 0.377–13.517 | |||
Aortic cross-clamp time | 0.590 | 1.009 | 0.976–1.043 | |||
BCPS pathway size | ||||||
Small central PA | 0.547 | 1.741 | 0.287–10.565 | |||
Diameter of right SVC | 0.605 | 0.882 | 0.548–1.420 | |||
Diameter of left SVC | 0.071 | 1.306 | 0.978–1.745 | |||
Diameter of right PA | 0.750 | 1.052 | 0.770–1-438 | |||
Diameter of left PA | 0.109 | 1.280 | 0.946–1.730 | |||
Diameter of central PA | 0.692 | 1.050 | 0.824–1.339 | |||
Distance between SVCs | 0.017 | 1.075 | 1.013–1.140 | |||
TCPC conduit diameter | 0.866 | 0.941 | 0.466–1.903 | |||
BCPS flow dynamics | ||||||
CPA flow right to left | 0.124 | 0.178 | 0.020–1.604 | |||
CPA flow left to right | 0.124 | 5.618 | 0.623–50.00 | |||
Discordant relationship between dominant SVC and IVC | 0.019 | 13.880 | 1.529–125.99 | 0.019 | 13.880 | 1.529–125.98 |