Bidirectional cavopulmonary shunt with an additional source of pulmonary flow: an interim or final stage of palliation

A bidirectional cavopulmonary shunt is performed in patients with single ventricle physiology to improve or maintain systemic oxygenation while decreasing the workload of the heart. During a period of 10 years, bidirectional cavopulmonary shunts were performed in 50 patients at our institution. The procedure was performed with an additional source of pulmonary flow through the pulmonary valve or a systemic to pulmonary shunt in 27 patients and without an additional source of pulmonary flow in 23 patients. Preoperative and postoperative chest radiographs, pulmonary angiograms, oxygenation, hemodynamic measurements, morbidity, and mortality were reviewed to determine whether a bidirectional cavopulmonary shunt with an additional source of pulmonary flow is an acceptable interim or final stage of palliation. Systemic oxygenation was improved only in patients with an additional source of pulmonary flow. The outcome of the bidirectional cavopulmonary shunt was not adversely affected by the presence of additional pulmonary flow Twenty-five patients subsequently underwent an atrial to pulmonary or total cavopulmonary anastomosis. Oxygenation was improved by more definitive palliation; however, late complications of stroke, protein losing enteropathy, and arrhythmias requiring pacemaker therapy were more prevalent. In conclusion, systemic oxygenation can be improved by performing the bidirectional cavopulmonary shunt with an additional source of pulmonary flow through the pulmonary valve or a systemic to pulmonary shunt without an adverse effect on hemodynamic measurements, pulmonary arterial growth, morbidity, or survival. The bidirectional cavopulmonary shunt may be an acceptable final stage of palliation in some patients with a functionally single ventricle.