Surgical Pulmonary Arterioplasty at Bidirectional Cavopulmonary Anastomosis Leads to Favorable Pulmonary Hemodynamics at Final Stage Palliation

OBJECTIVE PA plasty at BDCA is associated with increased morbidity, but outcomes to final stage palliation are unknown. We sought to determine the impact of PA plasty on pulmonary artery growth and hemodyamics at Fontan. METHODS We retrospectively reviewed clinical data and outcomes for BDCA patients from 2006-2018. PA plasty was categorized by extent (Type 1-4) as previously described. Outcomes included PA re-intervention and mortality before final palliation. RESULTS 588 patients underwent BDCA. 179 patients (30.0%) underwent concomitant PA plasty. 570 (97%) patients (169 (94%) PA plasty) survived to BDCA discharge. 140/570 survivors (25%) required PA/Glenn reintervention prior to final stage palliation, (59/169 (35%) PA plasty; 81/401 (20%) non-PA plasty, p<0.001). 12, 24, 36-month freedom from reintervention after BDCA was 80% (95%CI: 74-86%), 75% (69-82%), 64% (57-73%) for PA plasty, and 95% (95%CI: 93-97%), 91% (88-94), 81% (76-85) for non-PA plasty (p<0.001). Pre-final stage mortality was 37 (6.3%) (14/169 PA plasty; 23/401 non-PA plasty, p=0.4). 504 (144 PA plasty; 360 non-PA plasty) patients reached final stage palliation (471 Fontan, 26 1.5-ventricle, 7 biventricular repair). Pre-Fontan PA pressure and PVR were 10(9-12) mmHg and 1.6(1.3-1.9) in PA plasty and 10(8-12) mmHg and 1.5(1.3-1.9) in non-PA plasty patients (p=0.29, 0.6). Fontan hospital mortality, length of stay, and morbidity were similar. CONCLUSION PA plasty at BDCA does not confer additional mortality risk leading to final palliation. Despite increased PA reintervention, there was reliable PA growth and favorable pulmonary hemodynamics at final stage palliation.