Damus Kaye Stansel

Provided by "Pediatric Heart Surgery — a reference for professionals"

The Damus-Kaye-Stansel procedure is used to relieve systemic outflow tract obstruction, usually in patients with single ventricular type anatomy. The unobstructed pulmonary outflow is used to provide relief of systemic outflow obstruction. A modified Blalock-Taussig shunt or cavopulmonary shunt is required to provide pulmonary blood flow following the Damus-Kaye-Stansel anastomosis.

Surgical technique

The Damus procedure requires cardiopulmonary bypass and aortic cross-clamping. The pulmonary artery is divided proximal to the bifurcation of its left and right branches. The distal pulmonary artery is closed with a patch. The proximal pulmonary artery is then sewn to the aorta, often using an interposed patch of cryopreserved homograft, as depicted in the illustration. Pulmonary artery blood supply is provided by a modified Blalock-Taussig shunt or cavopulmonary shunt. Transesophageal echocardiography is performed to help assess adequacy of repair. Cardiopulmonary bypass time and aortic cross-clamp time required to perform the Damus procedure are usually moderate in length. Delayed sternal closure is occasionally required to maintain satisfactory hemodynamics during the early postoperative period.

Postoperative considerations

The postoperative course following the Damus procedure can be variable, and depends on the individual anatomy and intraoperative course. Invasive monitors used include arterial and central venous catheters. Atrial lines are used when needed for access and/ or hemodynamic management. Measurement of preload to the ventricle allows for titration of volume replacement and adjustment of vasoactive infusions. Non-invasive monitors include NIRS (near infrared spectroscopy) probes to assess adequacy of regional and global perfusion and traditional pulse oximetry. Vasoactive agents might include epinephrine and/ or milrinone. Numerous other agents are available and are tailored to the specific needs of the patient, targeting adequate oxygen delivery to the tissues of the body and optimization of cardiac output.

Postoperative bleeding is a known potential complication since numerous suture lines are exposed to systemic level pressure. Low cardiac output with hemodynamic instability is occasionally encountered following surgery. The postoperative considerations described in the Norwood procedure would apply to patients in whom a Blalock-Taussig shunt provides pulmonary blood supply (see Norwood Procedure for Hypoplastic Left Heart Syndrome). The postoperative considerations described in the cavopulmonary shunt procedure would apply to patients in whom a cavopulmonary shunt provides pulmonary blood supply (see Single Ventricle or Tricuspid Atresia). Length of hospital stay required following the Damus procedure is variable, but 1 to 3 weeks is average.