Outcomes of the Kawashima: A Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis.

BACKGROUND: We aimed to evaluate the effect of age at operation on post-operative outcomes in children undergoing a Kawashima operation.

METHODS: The STS-CHSD was queried for Kawashima procedures from January 1, 2014 to June 30, 2020. Patients were stratified by age at surgery in months: 0-<4, 4-<8, 8-<12 and >12. Subsequently, outcomes for those in which the Kawashima was not the index operation, and those undergoing hepatic vein incorporation (Fontan completion or hepatic vein-to-azygos vein connection) were evaluated.

RESULTS: We identified 253 patients who underwent a Kawashima (median age 8.6 months and weight 7.4 kg); 12 (4.7%) 0-<4 months, 96 (37.9%) 4-<8 months, 81 (32.0%) 8-<12 months and 64 (25.3%) >12 months. Operative Mortality was 0.8% (n=2) with major morbidity/mortality in 17.4% (n=44); neither different across age groups. Patients <4 months had a longer post-operative length of stay (12.5 vs 9.3 days; p=0.03). The Kawashima was not the index operation of the hospital admission in 15 (5.9%), these patients were younger (6.0 vs 8.4 months; p=0.05) and had more preoperative risk factors (13/15 [92.9%] vs 126/238 [52.9%]; p<0.01). We identified 173 patients undergoing subsequent hepatic vein incorporation (median age 3.9 years and weight 15.0 kg) with Operative Mortality in 6 (3.5%) and major morbidity/mortality in 30 (17.3%).

CONCLUSIONS: The Kawashima is typically performed between 4 and 12 months with low mortality. Morbidity and mortality were not impacted by age. Hepatic vein incorporations may be higher risk than traditional Fontan procedures, and ways to mitigate this should be sought.