Impact of aortopulmonary collaterals on adverse events after total cavopulmonary connection
Takuya Osawa, Thibault Schaeffer, Kristina Borgmann, Mervin Schmiel, Helena Staehler, Chiara Di Padua, Paul Philipp Heinisch, Nicole Piber, Masato Mutsuga, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine
- General Medicine
- Surgery
Abstract
Background
Effects of aortopulmonary collaterals (APCs) on outcomes after the total cavopulmonary connection (TCPC) are unclear. This study evaluated the incidence of APCs before and after TCPC and analyzed the impacts of APCs on adverse outcomes.
Methods
A total of 585 patients, who underwent TCPC from 1994 to 2020 and whose preoperative angiographies were available, were included. Pre-TCPC angiograms in all patients were used for the detection of APCs, and post-TCPC angiograms were evaluated in selected patients. Late adverse events included late death, protein-losing enteropathy (PLE), and plastic bronchitis (PB).
Results
Median age at TCPC was 2.3 (1.8–3.4) years with a body weight of 12 (11–14) kg. APCs were found in 210 patients (36%) before TCPC and in 81 (14%) after TCPC. The closure of APCs was performed in 59 patients (10%) before TCPC, in 25 (4.2%) at TCPC, and in 59 (10%) after TCPC. The occurrences of APCs before and after TCPC were not associated with short-term or mid-term mortality. The APCs before TCPC were associated with chylothorax (p = 0.025), prolonged chest tube duration (p = 0.021), and PB (p = 0.008). The APCs after TCPC were associated with PLE (p < 0.001) and PB (p < 0.001). With APCs following TCPC, freedom from PLE and PB was lower than without (p < 0.001, p < 0.001).
Conclusions
APCs before TCPC were associated with chylothorax, prolonged chest tube duration, and PB. APCs after TCPC were associated with both PLE and PB. The presence of APCs might affect the lymph drainage system and increase the incidence of chylothorax, PLE, and PB.