Kawashima procedure in single ventricle palliation: the factors affecting clinical outcomes.

Abstract

Background: The superior cavopulmonary anastomosis (SCPA) is a standard second stage procedure in single ventricle palliation. Exact timing in most single ventricle patients depends on clinical status, age, weight and in many centers a preoperative catheterization. In this study, we aimed to investigate the factors affecting the length of hospital stay after Kawashima procedure and present our center outcomes.

Methods: We studied on our center's database between 2011 and 2024. Patients who underwent Kawashima procedure were analyzed for weight, height, and age as factors that may affect outcomes such as hospital stay, complications, and mortality. The effect of surgical timing on postoperative outcomes was examined. The primary outcome was length of stay.

Results: We found that 15 (6.4%) of the 233 patients who underwent SCPA had interrupted inferior vena cava (IIVC) and therefore underwent the Kawashima procedure. The median age was 5.9 months (IQR, 5.2-11.2), with a 2:1 female to male distribution, and the median weight was 7.5 kg (IQR, 5.5-9.5). Of note, 4 of the patients did not have any prior surgical intervention, others were palliated with pulmonary artery (PA) band (n = 3), Blalock-Taussing (BT) shunt (n = 2), Norwood procedure (n = 3), or central shunt (n = 3). There was no mortality, and the median postoperative length of hospital stay was 9 days (IQR, 6-11). Our regression analysis showed statistically significant relationship between age and postoperative length of hospital stay (R2-adj = 0.27, p = 0.032) as well as height and postoperative length of hospital stay (R2-adj = 0.28, p = 0.03). The weight did not reach statistical significance (p = 0.13). The overall survival rate was 100% after the Kawashima procedure, and 12 patients underwent Fontan completion with hepatic vein incorporation.

Conclusions: Our small study suggests that age and height may have a determining effect on the length of hospital stay and its associated conditions for this procedure.