Prevalence of Complications Following Unifocalization and Pulmonary Artery Reconstruction Procedures

Abstract

Background: Unifocalization and pulmonary artery reconstructions have been developed to treat complex disorders of pulmonary artery development. These procedures require extremely long periods of cardiopulmonary bypass (CPB) to facilitate surgical repair. The objective of this study was to document the prevalence of complications in patients undergoing unifocalization or pulmonary artery reconstructions associated with prolonged periods of CPB. Methods: This was a retrospective review of 100 consecutive patients who underwent unifocalization (n = 66) or pulmonary artery reconstructions (n = 34) with CPB times in excess of five hours. Thirty-eight of these operations were primary procedures, whereas 62 were reoperations. Results: The median age at surgery was 15 months, median duration of CPB was 473 minutes, median number of postoperative complications was 5, and the median length of hospital stay was 24 days. The most frequently encountered complications were low cardiac output (43%), open sternum (40%), reintubation (24%), arrhythmia (17%), and bronchoscopy (17%). There was a correlation between the total number of complications and overall length of hospital stay ( R 2 = 0.64). Major adverse cardiac events (MACE) occurred in 11 patients with one hospital mortality. Patients who experienced MACE had a median length of stay that was 35 days longer (56 vs 21 days) than patients who did not experience MACE. Conclusions: The data demonstrate that complications were relatively frequent in this cohort of patients and had a linear association with hospital length of stay. Major adverse cardiac events were encountered at a modest prevalence but had a profound impact on measures of outcome.

The number of postoperative surgical or diagnostic procedures following congenital heart surgery correlates with both mortality and hospital length of stay

“…For example, patients experiencing a cardiac arrest and/or who require cannulation for extracorporeal membrane oxygenator will be impacted in a more significant manner than patients who undergo a single bronchoscopy or delayed sternal closure. In a previous study evaluating the prevalence of complications in patients undergoing complex pulmonary artery reconstructions, we found that six complications had a significant impact on hospital length of stay 9 . These six complications included major adverse cardiac events (+35 days), unplanned major reoperation (+20 days), pneumonia (+15 days), re‐intubation (+14 days), bleeding (+11 days), and pleural effusion (+6 days).…”

Surgical Repair of Supravalvar Aortic Stenosis in Association With Transverse and Proximal Descending Aortic Abnormalities

“…In a study of 100 patients undergoing complex pulmonary artery reconstructions with cardiopulmonary bypass times in excess of 300 min, the median number of complications was 4, and median hospital length of stay was 24 days. 36 Thus, this may be the “price” that one must pay for performing procedures with very long cardiopulmonary bypass times (there was a sole mortality resulting in a 99% rate of survival to discharge). In the current study, there were 2 patients with a history of sudden cardiac arrest in whom the decision was made preoperatively not to address the presence of concomitant peripheral pulmonary artery stenosis.…”

A Deep Dive Into Retroesophageal Major Aortopulmonary Collateral Arteries

“…2 This anatomic variability becomes clinically relevant when MAPCAs are used in the reconstruction of a pulmonary vascular bed. [3][4][5][6][7][8][9] Many groups have adopted the "unifocalization" of MAPCAs for the treatment of PA/VSD/MAPCAs. [10][11][12][13] One anatomic variation of MAPCAs is those that traverse behind the esophagus en route to the lung parenchyma.…”

“…2 This anatomic variability becomes clinically relevant when MAPCAs are used in the reconstruction of a pulmonary vascular bed. 3–9 Many groups have adopted the “unifocalization” of MAPCAs for the treatment of PA/VSD/MAPCAs. 10–13…”