Pulsatile bidirectional Glenn is associated with better pulmonary artery growth, which might improve long-term outcomes after Fontan. However, it was associated with a higher postoperative complication rate.
Background Patients with antegrade pulmonary blood flow after a bidirectional cavopulmonary shunt (Glenn) may have better pulmonary artery growth. This study evaluated pulmonary artery growth in patients with and without prior additional pulsatile antegrade flow in a Glenn shunt at midterm follow-up after a Fontan procedure. Methods We reviewed 212 patients who had single-ventricle palliation in a 10-year period;103 (33 in pulsatile group 1 and 70 in nonpulsatile group 2) were selected for analysis. Data on demographics, procedures, perioperative course, and midterm follow-up after the Fontan procedure were compared. Echocardiography data were collected. Pulmonary artery sizes measured at cardiac catheterization and follow-up echocardiograms were used to calculate the Nakata index. Results Perioperative details were comparable in both groups, mean pulmonary artery pressure and systemic oxygen saturations were higher in group 1 compared to group 2. Venovenous collaterals were increased in group 1. There was a significant difference in the pre-Fontan and follow-up Nakata index between groups. There was a significant increase in the Nakata index in group 1 between the pre-Glenn and pre-Fontan assessments as well as the Nakata index between the pre-Fontan and midterm follow-up. There was no significant change in the Nakata index in group 2 between assessments. Conclusions A pulsatile Glenn shunt is associated with better pulmonary artery growth which continues long after the additional pulsatile flow is eliminated. It is possible that the effects of anterograde pulmonary blood flow on pulmonary artery growth in early life continue long after the Fontan completion.
The described technique may decrease the incidence of recoarctation after S1P by minimizing aortic arch and descending aorta distortion and providing ample enlargement of the aorta at its narrowest diameter.
Background: Aortic cusp extension is a technique for
aortic valve (AV) repairs in pediatric patients. The choice of the
material used in this procedure may influence the time before
reoperation is required. We aimed to assess post-operative and long-term
outcomes of patients receiving either pericardial or synthetic
repairs.
Methods: We conducted a single center, retrospective study of
pediatric patients undergoing aortic cusp extension valvuloplasty (N=38)
with either autologous pericardium (n=30) or CorMatrix (n=8) between
April 2009 and July 2016. Short and long-term postoperative outcomes
were compared between the two groups. Freedom from reoperation was
compared using Kaplan Meier analysis. Degree of aortic stenosis (AS) and
aortic regurgitation (AR) were recorded at baseline, post-operatively,
and at outpatient follow-up.
Results: At five years after repair, freedom from reoperation was
significantly lower in the CorMatrix group (12.5%) compared to
the pericardium group (62.5%) (P = 0.01). For the entire cohort,
there was a statistically significant decrease in the peak trans-valvar
gradient between pre- and post-operative assessments with no significant
change at outpatient follow-up. In the pericardium group, 28 (93%) had
moderate to severe AR at baseline which improved to 11 (37%)
post-operatively and increased to 21 (70%) at time of follow-up. In the
biomaterial group, 8 (100%) had moderate to severe AR which improved to
3 (38%) post-operatively and increased to 7 (88%) at time of
follow-up.
Conclusion: In terms of durability, the traditional autologous
pericardium may outperform the new CorMatrix for AV repairs using the
cusp extension method.
Background: Aortic cusp extension is a technique for aortic valve (AV)
repairs in pediatric patients. The choice of the material used in this
procedure may influence the time before reoperation is required. We
aimed to assess post-operative and long-term outcomes of patients
receiving either pericardial or synthetic repairs. Methods: We conducted
a single center, retrospective study of pediatric patients undergoing
aortic cusp extension valvuloplasty (N=38) with either autologous
pericardium (n=30) or Cormatrix (n=8) between April 2009 and July 2016.
Short and long-term postoperative outcomes were compared between the two
groups. Freedom from reoperation was compared using Kaplan Meier
analysis. Degree of aortic stenosis (AS) and aortic regurgitation (AR)
were recorded at baseline, post-operatively, and at outpatient
follow-up. Results: At five years after repair, freedom from reoperation
was significantly lower in the CorMatrix group (12.5%) compared to the
pericardium group (62.5%) (P = 0.01). For the entire cohort, there was
a statistically significant decrease in the peak trans-valvar gradient
between pre- and post-operative assessments with no significant change
at outpatient follow-up. In the pericardium group, 28 (93%) had
moderate to severe AR at baseline which improved to 11 (37%)
post-operatively and increased to 21 (70%) at time of follow-up. In the
biomaterial group, 8 (100%) had moderate to severe AR which improved to
3 (38%) post-operatively and increased to 7 (88%) at time of
follow-up. Conclusion: In terms of durability, the traditional
autologous pericardium may outperform the new CorMatrix for AV repairs
using the cusp extension method.
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