The Impact of Dominant Ventricular Morphology on the Early Postoperative Course After the Glenn Procedure.
Glenn procedure
Pediatric cardiac critical care
Single ventricle
Ventricular morphology
Journal
Pediatric cardiology
ISSN: 1432-1971
Titre abrégé: Pediatr Cardiol
Pays: United States
ID NLM: 8003849
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
28
12
2022
accepted:
23
01
2023
medline:
29
5
2023
pubmed:
14
2
2023
entrez:
13
2
2023
Statut:
ppublish
Résumé
The dominant ventricular morphology affects both the early and late outcomes of the Fontan procedure, but its impact on the patients' status immediately following the Glenn procedure is unknown. This study aims to evaluate the effect of the infants' dominant ventricular morphology on the immediate course after undergoing the Glenn procedure. This single-center, retrospective study included all patients who underwent the Glenn procedure between October 2003 and May 2016. The patients were divided into two groups according to their dominant ventricular morphology. Their postoperative records were reviewed and compared. Out of the 89 patients who underwent the Glenn procedure during the study period, 40 (44.9%) had dominant right ventricular morphology and 49 (55.1%) had left ventricular morphology. There were no significant group differences in baseline characteristics or operative data. The maximal postoperative vasoactive-inotropic score was significantly higher and the extent of ventricular dysfunction was significantly more severe in the dominant right ventricle group (P < 0.05). The length of hospitalization was slightly but not significantly longer in the hypoplastic LV group. It is concluded that patients with a dominant LV morphology had a superior ventricular function and required less inotropic support compared to that of a dominant RV morphology in the immediate postoperative course following the Glenn procedure. Survival was not affected by these differences. Further study to determine the pathophysiologic basis for these differences is warranted.
Identifiants
pubmed: 36781464
doi: 10.1007/s00246-023-03114-z
pii: 10.1007/s00246-023-03114-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1076-1082Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Baker-Smith CM, Goldberg SW, Rosenthal GL (2015) Predictors of prolonged hospital length of stay following stage II palliation of hypoplastic left heart syndrome (and variants): analysis of the national pediatric cardiology quality improvement collaborative (NPC-QIC) database. Pediatr Cardiol 36:1630–1641
doi: 10.1007/s00246-015-1208-3
pubmed: 26036350
Davies RR, Pizarro C (2015) Decision-making for surgery in the management of patients with univentricular heart. Front Pediatr. https://doi.org/10.3389/fped.2015.00061
doi: 10.3389/fped.2015.00061
pubmed: 26284226
pmcid: 4515559
Talwar S, Jaiswal LS, Choudhary SK, Saxena A, Juneja R, Kothari SS, Airan B (2014) Retrospective study of results of Kawashima procedure. Heart Lung Circ 23(7):674–679
doi: 10.1016/j.hlc.2014.01.016
pubmed: 24702981
Iyengar AJ, Winlaw DS, Galati JC, Wheaton GR, Gentles TL, Grigg LE, Justo RN, Radford DJ, Weintraub RG, Bullock A, Celermajer DS, d’Udekem Y (2014) The extracardiac conduit fontan procedure in Australia and New Zealand: hypoplastic left heart syndrome predicts worse early and late outcomes. Eur J Cardiothorac Surg 46(3):465–473
doi: 10.1093/ejcts/ezu015
pubmed: 24578409
Schumacher KR, Stringer KA, Donohue JE, Yu S, Shaver A, Caruthers RL, Zikmund-Fisher BJ, Fifer C, Goldberg C, Russell MW (2015) Fontan-associated protein-losing enteropathy and plastic bronchitis. J Pediatr 166(4):970–977
doi: 10.1016/j.jpeds.2014.12.068
pubmed: 25661406
pmcid: 4564862
McIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF (2017) Validation of the vasoactive-inotropic score in pediatric sepsis. Pediatr Crit Care Med 18(8):750–757
doi: 10.1097/PCC.0000000000001191
pubmed: 28486385
pmcid: 5548505
Weddell JS, Nersesian M, Mussatto KA et al (2009) Fontan palliation in the modern era: factors impacting mortality and morbidity. Ann Thorac Surg 88(4):1291–1299
doi: 10.1016/j.athoracsur.2009.05.076
Pollak U, Abarbanel I, Salem Y, Serraf AE, Mishaly D (2022) Dominant ventricular morphology and early postoperative course after the fontan procedure. World J Pediatr Congenit Heart Surg 13(3):346–352
doi: 10.1177/21501351221081246
pubmed: 35446208
pmcid: 9024023
Unseld B, Stiller B, Borth-Bruhns T, du Bois F, Kroll J, Grohmann J, Fleck T (2017) An early glenn operation may be associated with the later occurrence of protein-losing enteropathy in Fontan patients. Pediatr Cardiol 38(6):1155–1161
doi: 10.1007/s00246-017-1632-7
pubmed: 28534240
Kamata M, Stiver C, Naguib A, Tumin D, Tobias J (2017) A retrospective analysis of the influence of ventricular morphology on the perioperative outcomes after Fontan surgery. J Cardiothorac Vasc Anesth 31(1):128–133
doi: 10.1053/j.jvca.2016.07.024
pubmed: 27720490
Ghelani SJ, Colan SD, Azcue N, Keenan EM, Harrild DM, Powell AJ, Geva T, Rathod RH (2018) Impact of ventricular morphology on fiber stress and strain in Fontan patients. Circ Cardiovasc Imaging 11(7):e006738
doi: 10.1161/CIRCIMAGING.117.006738
pubmed: 29970379
Suntratonpipat S, Khoo NS, Colen T, Alhabdan M, Troung D, Zahari N, Kutty S, Smallhorn JF, Tham EB (2017) Impaired single right ventricular function compared to single left ventricles during the early stages of palliation: a longitudinal study. J Am Soc Echocardiogr 30(5):468–477
doi: 10.1016/j.echo.2017.01.001
pubmed: 28268110
Sanil Y, Aggarwal S (2013) Vasoactive-inotropic score after pediatric heart transplant: a marker of adverse outcome. Pediatr Transplant 17(6):567–572
doi: 10.1111/petr.12112
pubmed: 23773439
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, Charpie JR, Hirsch JC (2010) Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 11(2):234–238
doi: 10.1097/PCC.0b013e3181b806fc
pubmed: 19794327
Davidson J, Tong S, Hancock H, Hauck A, da Cruz E, Kaufman J (2012) Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med 38(7):1184–1190
doi: 10.1007/s00134-012-2544-x
pubmed: 22527067
pmcid: 4984395
Lofland GK (2001) The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J Cardiothorac Surg 20(1):114–118
doi: 10.1016/S1010-7940(01)00757-6
pubmed: 11423283
Zakaria D, Rettiganti M, Gossett JM, Gupta P (2017) Factors associated with early extubation after superior cavopulmonary connection: analysis from single ventricle reconstruction trial. Acta Anaesthesiol Scand 61(7):722–729
doi: 10.1111/aas.12915
pubmed: 28568112
d’Udekem Y, Xu MY, Galati JC, Lu S, Iyengar AJ, Konstantinov IE, Wheaton GR, Ramsay JM, Grigg LE, Millar J, Cheung MM, Brizard CP (2012) Predictors of survival after single-ventricle palliation. J Am Coll Cardiol 59:1178–1185
doi: 10.1016/j.jacc.2011.11.049
pubmed: 22440217