TY - JOUR
T1 - Bidirectional Cavopulmonary Shunt for Right Ventricular Unloading
AU - Stephens, Elizabeth H.
AU - Qureshi, Muhammad Yasir
AU - Anderson, Jason H.
AU - Ashikhmina, Elena
AU - Dearani, Joseph A.
N1 - Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/5
Y1 - 2021/5
N2 - Background: Right-sided heart failure remains a challenge in the care of congenital heart disease patients, both those with right ventricular dilation and dysfunction and those with right ventricular hypoplasia. Two strategies for treatment are atrial septal fenestration and bidirectional cavopulmonary shunt (BCPS). Methods: This review details the strategies for right ventricular unloading, with summaries of pertinent data and commentaries on the subject. Results: While atrial septal fenestration provides right ventricular unloading and can be appropriate in cases of moderate right ventricular dysfunction and dilation, this unloading is not as substantial as a BCPS. A BCPS more effectively unloads the right ventricle, provides preload to the left ventricle, and can significantly improve ventricular-ventricular interactions. A BCPS is often appropriate in cases of severe right ventricular dysfunction and dilation, if factors favorable for BCPS circulation are in place. Certain anatomic and physiologic factors assessed both preoperatively and intraoperatively help guide the decision regarding which patient may benefit from right ventricular unloading and which technique is optimal. Conclusions: When used strategically in select patients, BCPS and atrial-level fenestration are effective in managing right ventricular failure in congenital heart disease patients. Preoperative imaging and intraoperative anatomic and physiologic factors help guide the appropriate management for a given patient.
AB - Background: Right-sided heart failure remains a challenge in the care of congenital heart disease patients, both those with right ventricular dilation and dysfunction and those with right ventricular hypoplasia. Two strategies for treatment are atrial septal fenestration and bidirectional cavopulmonary shunt (BCPS). Methods: This review details the strategies for right ventricular unloading, with summaries of pertinent data and commentaries on the subject. Results: While atrial septal fenestration provides right ventricular unloading and can be appropriate in cases of moderate right ventricular dysfunction and dilation, this unloading is not as substantial as a BCPS. A BCPS more effectively unloads the right ventricle, provides preload to the left ventricle, and can significantly improve ventricular-ventricular interactions. A BCPS is often appropriate in cases of severe right ventricular dysfunction and dilation, if factors favorable for BCPS circulation are in place. Certain anatomic and physiologic factors assessed both preoperatively and intraoperatively help guide the decision regarding which patient may benefit from right ventricular unloading and which technique is optimal. Conclusions: When used strategically in select patients, BCPS and atrial-level fenestration are effective in managing right ventricular failure in congenital heart disease patients. Preoperative imaging and intraoperative anatomic and physiologic factors help guide the appropriate management for a given patient.
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U2 - 10.1016/j.athoracsur.2020.06.037
DO - 10.1016/j.athoracsur.2020.06.037
M3 - Review article
C2 - 32828750
AN - SCOPUS:85103133995
SN - 0003-4975
VL - 111
SP - 1435
EP - 1441
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -