Background : The bidirectional superior cavopulmonary connection (BSCC) is widely used in the palliation of univentricular hearts (UVH). The use of extracorporeal circulation (ECC), aortic cross-clamping, and preservation or adjunction of an accessory source of pulmonary flow remain controversial . For the last 5 years, we have adopted a strategy using ECC, aortic cross clamping for any intracardiac repair , and suppression of all other sources of pulmonary flow at the time of BSCC.
Methods and Results : From January 1997 to May 2002, 43 consecutive patients underwent intermediate palliation of UVH by BSCC (21 had undergone an initial pulmonary flow regulatory procedure). Mean age was 17,1 11,6 months. Fourty-one patients (95%) left the operating room with the BSCC as the sole source of pulmonary flow. The aorta was clamped in 27 patients (63 %). Twenty-eight patients (65 %) had ancillary repairs : mainly reconstruction of the pulmonary bifurcation (n=18), and atrial septectomy (n=16).
Twenty-nine patients (70%) were extubated in the OR including 17 patients with a period of cross-clamping (30 13 min). Mean arterial saturation on arrival in the PICU was 81 6 %. Two patients (5%) died in the hospital. There was no prolonged pleural drainage. All BSCC were functional at discharge with a mean O2 saturation of 82 2 % (plethysmography).
Conclusion : BSCC under ECC is an excellent intermediate palliation for UVH. Aortic cross clamping, if necessary, has no deleterious effect on immediate function of the shunt nor on early extubation. Elimination of all accessory sources of pulmonary flow limits cardiac failure and duration of pleural drainage without excessive desaturation, setting the stage for a safe subsequent total cavopulmonary connection.