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Impact of pulmonary artery size on early haemodynamic and laboratory variables following total cavopulmonary connection

Published online by Cambridge University Press:  19 May 2025

Chiara Di Padua Open the ORCID record for Chiara Di Padua [Opens in a new window] ,
Teresa Lemmen ,
Jonas Palm Open the ORCID record for Jonas Palm [Opens in a new window] ,
Muneaki Matsubara Open the ORCID record for Muneaki Matsubara [Opens in a new window] ,
Thibault Schaeffer Open the ORCID record for Thibault Schaeffer [Opens in a new window] ,
Nicole Piber ,
Andrea Amici Open the ORCID record for Andrea Amici [Opens in a new window] ,
Paul Philipp Heinisch Open the ORCID record for Paul Philipp Heinisch [Opens in a new window] ,
Stanimir Georgiev Open the ORCID record for Stanimir Georgiev [Opens in a new window]  and
Alfred Hager Open the ORCID record for Alfred Hager [Opens in a new window]
...Show all authors
Chiara Di Padua
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Teresa Lemmen
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Jonas Palm
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Muneaki Matsubara
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Thibault Schaeffer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Nicole Piber
Affiliation:
Department of Cardiovascular Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Andrea Amici
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Paul Philipp Heinisch
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Stanimir Georgiev
Affiliation:
Europäisches Kinderherzzentrum München, Munich, Germany Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Alfred Hager
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Peter Ewert
Affiliation:
Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany
Jürgen Hörer
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
Masamichi Ono*
Affiliation:
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany Europäisches Kinderherzzentrum München, Munich, Germany
*
Corresponding author: M Ono; Email: ono@dhm.mhn.de
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Abstract

Objective:

Current research suggests that a small pulmonary artery can cause adverse events and reduce exercise capacity after the Fontan procedure. This study aimed to evaluate the impact of pulmonary artery size on early haemodynamic and laboratory variables after total cavopulmonary connection.

Methods:

We reviewed all patients who underwent staged Fontan between 2012 and 2022. Pulmonary artery index before bidirectional cavopulmonary shunt and before total cavopulmonary connection was calculated according to Nakata and colleagues. We sought to analyse the impact of the pulmonary artery index on early haemodynamic and laboratory variables, including pulmonary artery pressure and mean arterial pressure 12 hours after extubation and lactate levels 6 hours after extubation.

Results:

A total of 263 patients were included. Median age and weight at total cavopulmonary connection were 2.2 (interquartile ranges: 1.8–2.7) years and 11.7 (interquartile range: 10.7–13.3) kg, respectively. Before that, all patients underwent bidirectional cavopulmonary shunt at a median age of 4.1 (interquartile range: 3.2–5.8) months. In the multivariable analysis, pre-bidirectional cavopulmonary shunt pulmonary artery index (p = 0.016, odds ratio 0.993), with a cut-off value of 154 mm2/m2 was an independent risk factor for a higher pulmonary artery pressure (> 17 mmHg). No variable was identified as a significant risk factor for lower mean arterial pressure (< 57 mmHg). Regarding lactate levels (> 4.5 mg/dl), pre-bidirectional cavopulmonary shunt right pulmonary artery index (p < 0.001, odds ratio 0.983), with a cut-off value of 70 mm2/m2 was identified as an independent risk factor.

Conclusions:

In patients with staged Fontan palliation, a small pulmonary artery size before bidirectional cavopulmonary shunt and total cavopulmonary connection was a determinant factor associated with unfavourable early postoperative haemodynamics after total cavopulmonary connection.

Keywords

Single ventriclepulmonary artery sizebidirectional cavopulmonary shunttotal cavopulmonary connectionhaemodynamic variables

Information

Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 5 , May 2025 , pp. 1002 - 1010
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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