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Can the Kawashima procedure be performed in younger patients?

Publication ,  Journal Article
Nath, DS; Carden, AJ; Nussbaum, DP; Shin, AJ; Khemani, RG; Starnes, VA; Wells, WJ
Published in: Ann Thorac Surg
August 2009

BACKGROUND: The prudence of performing early palliative cavopulmonary connection that includes superior vena cava in association with azygous-hemiazygous continuation of the inferior vena cava, Kawashima procedure (KP), has been questioned. We document our experience with KP performed at a relatively younger age than usually reported. METHODS: A retrospective review of patients undergoing KP (October 2000 to April 2008) was done. RESULTS: Initial palliation was carried out in 13 of 15 patients. Age and weight at KP was 8.4 months (5.1 to 15.1) and 6.8 kg (4.6 to 11.0). The pre-KP catheterization showed the following: pulmonary artery pressure = 14.5 mm Hg (9 to 17); end-diastolic pressure of systemic ventricle = 8 (2 to 14); oxygenation saturation = 76% (63 to 82); and atrioventricular (AV) valve insufficiency moderate or greater in 5 patients. The post-KP characteristics included the following intubation = 1 day (0 to 19); nitric oxide = 4 patients; superior caval pressure = 14 mm Hg (6 to 18); inotrope score = 7.5 (2.5 to 14.3); intensive care unit stay = 3 days (1 to 9); hospital stay = 7 days (3 to 77); and oxygen saturation at discharge = 84% (76 to 90%). There was one hospital death that required takedown of KP. Fontan completion was performed in 8 patients at an interval of 2.7 years (1.8 to 5.8) after KP. There was one post-Fontan mortality from severe ventricular and AV valve dysfunction. Pulmonary arteriovenous malformations (PAVMs) were diagnosed in 4 patients with 3 resolving post-Fontan. With a median follow-up of 4.2 years (0.1 to 7.9), 13 of 15 remain alive yielding a series survival of 87%. CONCLUSIONS: The Kawashima procedure can be safely performed at an earlier age than previously reported. The incidence of PAVMs after the KP appears to be similar to other reports where KP was performed at a later age.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2009

Volume

88

Issue

2

Start / End Page

581 / 586

Location

Netherlands

Related Subject Headings

  • Vena Cava, Inferior
  • Retrospective Studies
  • Respiratory System
  • Pulmonary Artery
  • Patient Selection
  • Male
  • Infant
  • Humans
  • Hepatic Veins
  • Heart Ventricles
 

Citation

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Nath, D. S., Carden, A. J., Nussbaum, D. P., Shin, A. J., Khemani, R. G., Starnes, V. A., & Wells, W. J. (2009). Can the Kawashima procedure be performed in younger patients? Ann Thorac Surg, 88(2), 581–586. https://doi.org/10.1016/j.athoracsur.2009.04.045
Nath, Dilip S., Anthony J. Carden, Daniel P. Nussbaum, Angela J. Shin, Robinder G. Khemani, Vaughn A. Starnes, and Winfield J. Wells. “Can the Kawashima procedure be performed in younger patients?Ann Thorac Surg 88, no. 2 (August 2009): 581–86. https://doi.org/10.1016/j.athoracsur.2009.04.045.
Nath DS, Carden AJ, Nussbaum DP, Shin AJ, Khemani RG, Starnes VA, et al. Can the Kawashima procedure be performed in younger patients? Ann Thorac Surg. 2009 Aug;88(2):581–6.
Nath, Dilip S., et al. “Can the Kawashima procedure be performed in younger patients?Ann Thorac Surg, vol. 88, no. 2, Aug. 2009, pp. 581–86. Pubmed, doi:10.1016/j.athoracsur.2009.04.045.
Nath DS, Carden AJ, Nussbaum DP, Shin AJ, Khemani RG, Starnes VA, Wells WJ. Can the Kawashima procedure be performed in younger patients? Ann Thorac Surg. 2009 Aug;88(2):581–586.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2009

Volume

88

Issue

2

Start / End Page

581 / 586

Location

Netherlands

Related Subject Headings

  • Vena Cava, Inferior
  • Retrospective Studies
  • Respiratory System
  • Pulmonary Artery
  • Patient Selection
  • Male
  • Infant
  • Humans
  • Hepatic Veins
  • Heart Ventricles