Palliative Surgery for Patients with Complex Congenital Heart Diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Cheng , DONG Nianguo , DU Xinling , HU Zhiwei , ZHANG Kailun , XIAO Shiliang , JIANG Xionggang.

Department of Cardiovascular Surgery， Union Hospital　of Tongji Medical College， Huazhong University of Science and Technology， Wuhan 430022， P. R. China;

Corresponding author：

Keywords：

Palliative surgery; ?Congenital heart disease; ? Cardiac surgery

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Objective　To study palliative surgical strategies for patients with complex congenital heart diseases， and improve their clinical outcomes and survival rate.?Methods　We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College，Huazhong University of Science and Technology from January 2004 to May 2011. There were 68 male patients and 27
female patients with their age ranging from 1 month to 37 years. Modified Blalock-Taussig shunt （B-T shunt） was performed　in 12 patients， modified Brock’s procedure in 23 patients， bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients. Surgical strategies and influential factors of treatment outcomes were analyzed.?Results　There were 10 in-hospital death with the overall mortality of 10.5% （10/95）. All the surviving patients were discharged successfully. Main postoperative complications included low cardiac output syndrome， hypoxemia and pneumonia. All the surviving patients were followed up for 5 months to 6 years， and in New York Heart Association （NYHA） functional class ⅠorⅡduring follow-up. During follow-up， nine patients after modified Brock’s procedure received radical repair， and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.?Conclusion　A considerable numberof patients with complex congenital heart diseases may miss their best timing for surgical repair， which significantly
influences their surgical outcomes. We need to choose best palliative surgical strategy for these patients according to their　pulmonary artery development condition， heart malformation characteristics and final treatment goal.

Citation： ZHOU Cheng,DONG Nianguo,DU Xinling,HU Zhiwei,ZHANG Kailun,XIAO Shiliang,JIANG Xionggang.. Palliative Surgery for Patients with Complex Congenital Heart Diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 494-497. doi: Copy

1.	Yuan SM， Jing H. Palliative procedures for congenital heart defects. Arch Cardiovasc Dis， 2009， 102 （6-7）：549-557.
2.	丁芳宝，梅举，邹良建，等. 非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病. 中国胸心血管外科临床杂志， 2005， 12 （1）：46-47.
3.	汪曾炜，刘维永，张宝仁，主编. 心脏外科学. 北京：人民卫生出版社， 2001. 896-899.
4.	郑景浩，徐志伟，苏肇伉，等. 体肺分流术在小儿复杂先天性心脏病手术中的应用. 中华胸心血管外科杂志， 2005， 12 （6）：371.
5.	Stark JF， de Leval MR， Tsang VT. Surgery for Congenital Heart Defects. 3rd ed. Chichester：John Wiley & Sons， Ltd， 2006. 251-259.
6.	Wells WJ， Yu RJ， Batra AS， et al. Obstruction in modified Blalock shunts：a quantitative analysis with clinical correlation. Ann Thorac Surg， 2005， 79 （6）：2072-2076.
7.	徐志伟，主编. 小儿心脏手术学. 北京：人民军医出版社， 2006. 275-276.
8.	Richard AJ. Comprehensive surgical management of congenital heart disease. London：Hodder arnold publication， 2004. 357-382.
9.	Kaulitz R， Hofbeck M. Current treatment and prognosis in children with functionally univentricular hearts. Arch Dis Child， 2005， 90 （7）：757-762.
10.	Fujii Y， SANO Shunji， Kotani Y， et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg， 2009， 87 （2）：562-570.
11.	Freedom RM， Benson LN， Smallhorn JF， et al. Subaortic stenosis， the univentricular heart， and banding of the pulmonary artery：an analysis of the courses of 43 patients with univentricular heart palliated by pulmonary artery banding. Circulation， 1986， 73 （4）：758-764.
12.	Bradley SM， Simsic JM， Atz AM， et al. The infant with single ventricle and excessive pulmonary blood flow：results of a strategy of pulmonary artery division and shunt. Ann Thorac Surg， 2002， 74 （3）：805-810.
13.	Freedom RM， Nykanen D， Benson LN. The physiology of the bidirectional cavopulmonary connection. Ann Thorac Surg，1998，66 （2）：664-667.
14.	Cleuziou J， Schreiber C， Cornelsen JK， et al. Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months. Eur J Cardiothorac Surg， 2008，34 （3）：550-554.
15.	Yoshida M， Yamaguchi M， Yoshimura N， et al. Appropriate additional pulmonary blood flow at the bidirectional Glenn procedure is useful for completion of total cavopulmonary connection. Ann Thorac Surg，2005，80 （3）：976-981.
16.	Berdat PA， Belli E， Lacour-Gayet F， et al. Additional pulmonary blood flow has no adverse effect on outcome after bidirectional cavopulmonary anastomosis. Ann Thorac Surg，2005，79 （1）：.
17.	Calvaruso DF， Rubino A， Ocello S， et al. Bidirectional Glenn and antegrade pulmonary blood flow：temporary or definitive palliation? Ann Thorac Surg， 2008，85 （4）：1389-1395.
18.	-36.

1. 　Yuan SM， Jing H. Palliative procedures for congenital heart defects. Arch Cardiovasc Dis， 2009， 102 （6-7）：549-557.
2. 　丁芳宝，梅举，邹良建，等. 非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病. 中国胸心血管外科临床杂志， 2005， 12 （1）：46-47.
3. 　汪曾炜，刘维永，张宝仁，主编. 心脏外科学. 北京：人民卫生出版社， 2001. 896-899.
4. 　郑景浩，徐志伟，苏肇伉，等. 体肺分流术在小儿复杂先天性心脏病手术中的应用. 中华胸心血管外科杂志， 2005， 12 （6）：371.
5. 　Stark JF， de Leval MR， Tsang VT. Surgery for Congenital Heart Defects. 3rd ed. Chichester：John Wiley & Sons， Ltd， 2006. 251-259.
6. 　Wells WJ， Yu RJ， Batra AS， et al. Obstruction in modified Blalock shunts：a quantitative analysis with clinical correlation. Ann Thorac Surg， 2005， 79 （6）：2072-2076.
7. 　徐志伟，主编. 小儿心脏手术学. 北京：人民军医出版社， 2006. 275-276.
8. 　Richard AJ. Comprehensive surgical management of congenital heart disease. London：Hodder arnold publication， 2004. 357-382.
9. 　Kaulitz R， Hofbeck M. Current treatment and prognosis in children with functionally univentricular hearts. Arch Dis Child， 2005， 90 （7）：757-762.
10. 　Fujii Y， SANO Shunji， Kotani Y， et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg， 2009， 87 （2）：562-570.
11. 　Freedom RM， Benson LN， Smallhorn JF， et al. Subaortic stenosis， the univentricular heart， and banding of the pulmonary artery：an analysis of the courses of 43 patients with univentricular heart palliated by pulmonary artery banding. Circulation， 1986， 73 （4）：758-764.
12. 　Bradley SM， Simsic JM， Atz AM， et al. The infant with single ventricle and excessive pulmonary blood flow：results of a strategy of pulmonary artery division and shunt. Ann Thorac Surg， 2002， 74 （3）：805-810.
13. 　Freedom RM， Nykanen D， Benson LN. The physiology of the bidirectional cavopulmonary connection. Ann Thorac Surg，1998，66 （2）：664-667.
14. 　Cleuziou J， Schreiber C， Cornelsen JK， et al. Bidirectional cavopulmonary connection without additional pulmonary blood flow in patients below the age of 6 months. Eur J Cardiothorac Surg， 2008，34 （3）：550-554.
15. 　Yoshida M， Yamaguchi M， Yoshimura N， et al. Appropriate additional pulmonary blood flow at the bidirectional Glenn procedure is useful for completion of total cavopulmonary connection. Ann Thorac Surg，2005，80 （3）：976-981.
16. 　Berdat PA， Belli E， Lacour-Gayet F， et al. Additional pulmonary blood flow has no adverse effect on outcome after bidirectional cavopulmonary anastomosis. Ann Thorac Surg，2005，79 （1）：.
17. 　Calvaruso DF， Rubino A， Ocello S， et al. Bidirectional Glenn and antegrade pulmonary blood flow：temporary or definitive palliation? Ann Thorac Surg， 2008，85 （4）：1389-1395.
18. -36.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Palliative Surgery for Patients with Complex Congenital Heart Diseases

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