Morbidity risk factors after total cavopulmonary shunt

Abstract

Introduction: Arrhythmia, ventricular dysfunction and decreased functional capacity appear in the surgical outcome of patients with total cavopulmonary shunt. Detection of risk factors for this morbidity is essential to improve outcomes.

Objective: To identify these risk factors in patients with intraatrial and extracardiac total cavopulmonary shunt.

Method: A prospective cohort study was conducted from January 1992 to January 2012 at William Soler Cardiology Hospital. Frequency distributions and contingency tables were built. The association between qualitative variables was analyzed by Ji-square test of independence, for quantitative, with the Student t test. The binary logistic regression was used to identify risk factors.

Results: 74 patients were studied at an average follow-up time of 8 years. Thirteen patients had arrhythmias and it was identified as a risk factor for postoperative occurrence of moderate or severe atrioventricular failure. Eleven patients developed moderate or severe ventricular dysfunction. Association with ventricular mass varia-tion was detected. Decreased functional capacity was detected in 33 patients with associated ventricular dysfunction.

Conclusions: Atrioventricular failure that appears after total cavopulmonary shunt should be treated since it is a risk factor for new arrhythmias. The decrease in ventri-cular mass in evolutionary studies should guide the diagnosis and treatment of ventricular dysfunction and decreased functional capacity in patients operated with total cavopulmonary shunt.