Bidirectional cavopulmonary anastomosis with additional pulmonary blood flow: Good or bad pre-Fontan strategy

OBJECTIVES: This study aimed to evaluate the influence of preserved additional pulmonary blood flow (APBF) on survival after bidirectional cavopulmonary shunt (BCPS) and completion of Fontan circulation. METHODS: From March 2003 and April 2015, 156 patients with a single ventricle underwent BCPS. After performing propensity score analysis (1:1) for the entire sample, 50 patients with APBF (APBF group) were matched with 50 patients without APBF (no-APBF group). RESULTS: Age (P = 0.90), sex (P = 0.57), weight (P = 0.75), single ventricle morphology (P=0.87), type of neonatal palliative procedure (P=0.52), saturation (P=0.35), ejection fraction (P=0.90), Nakata index (P = 0.70) and mean pulmonary artery pressure (P = 0.72) were not significantly different between the groups. No significant survival difference was demonstrated (P = 0.54). One and 4-year survival rates were both 89.1% ± 4.6% in the APBF group and 87.2% ± 4.9% and 83.4% ± 5.9%, respectively, in the no-APBF group. There was no significant difference in rates of Fontan completion (P = 0.24), which was achieved in 22 patients from the APBF group (55.0%) and 26 patients from the no-APBF group (65.0%). However, Fontan completion occurred significantly earlier in the no-APBF group (P < 0.01). In this group, Fontan procedure was performed before 36 months of inter-stage period in 45.9% ± 8.5% of cases (95% CI 31.0-63.7%) compared to only 13.3 ± 5.6% (95% CI 5.8-29.1%) in the APBF group. CONCLUSIONS: Our study demonstrates that APBF does not affect survival after BCPS or Fontan completion rate. APBF allows postponing the Fontan procedure without a negative effect on clinical status.