Bidirectional Glenn Procedure Improves the Mechanical Efficiency of a Total Cavopulmonary Connection in High-Risk Fontan Candidates

Tanoue, Yoshihisa; Sese, Akira; Ueno, Yasutaka; Joh, Kunitaka; Hijii, Takayuki

doi:10.1161/01.cir.103.17.2176

Cited by 119 publications

(101 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…by guest on May 12, 2018 http://circres.ahajournals.org/ Downloaded from are consistent with the fact that volume reduction by staged palliation could enhance ventricular contractility as well as mechanical efficiency, as shown by cardiac elastance measurement in this study. 22 Thus, the functional benefits of CDCs isolated from children in this study could be interpreted, at least in part, by previous reports on mouse and human demonstrating that the intrinsic pool of cardiac progenitor cells in human neonatal heart was found to have a higher capability to regenerate cardiomyocytes than that in adult myocardium. 6,7,39 The sample size of this exploratory trial was set as small, based on feasibility and the results of our preclinical trial, which could limit the statistical rigor and power and might not be sufficient to draw the preliminary conclusions related to safety and efficacy.…”

Section: Discussionsupporting

confidence: 51%

“…The approximations of E es (end-systolic elastance) and E a (effective arterial elastance) were calculated by pressure study and volume measurement, as previously reported. 22 cMRI scans were performed on a Philips 1.5 Tesla Achieva Scanner (Philips Healthcare, Netherlands) under general anesthesia. The phased array coil was selected.…”

Section: Cardiac Function Analysismentioning

confidence: 99%

See 1 more Smart Citation

Intracoronary Autologous Cardiac Progenitor Cell Transfer in Patients With Hypoplastic Left Heart Syndrome

Ishigami

Ohtsuki

Tarui

et al. 2015

Circulation Research

165

141

View full text Add to dashboard Cite

Rationale: Hypoplastic left heart syndrome (HLHS) remains a lethal congenital cardiac defect. Recent studies have suggested that intracoronary administration of autologous cardiosphere-derived cells (CDCs) may improve ventricular function. Objective: The aim of this study was to test whether intracoronary delivery of CDCs is feasible and safe in patients with hypoplastic left heart syndrome. Methods and Results: Between January 5, 2011, and January 16, 2012, 14 patients (1.8±1.5 years) were prospectively assigned to receive intracoronary infusion of autologous CDCs 33.4±8.1 days after staged procedures (n=7), followed by 7 controls with standard palliation alone. The primary end point was to assess the safety, and the secondary end point included the preliminary efficacy to verify the right ventricular ejection fraction improvements between baseline and 3 months. Manufacturing and intracoronary delivery of CDCs were feasible, and no serious adverse events were reported within the 18-month follow-up. Patients treated with CDCs showed right ventricular ejection fraction improvement from baseline to 3-month follow-up (46.9%±4.6% to 52.1%±2.4%; P =0.008). Compared with controls at 18 months, cardiac MRI analysis of CDC-treated patients showed a higher right ventricular ejection fraction (31.5%±6.8% versus 40.4%±7.6%; P =0.049), improved somatic growth ( P =0.0005), reduced heart failure status ( P =0.003), and lower incidence of coil occlusion for collaterals ( P =0.007). Conclusions: Intracoronary infusion of autologous CDCs seems to be feasible and safe in children with hypoplastic left heart syndrome after staged surgery. Large phase 2 trials are warranted to examine the potential effects of cardiac function improvements and the long-term benefits of clinical outcomes. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01273857.

show abstract

Section: Discussionsupporting

confidence: 51%

Section: Cardiac Function Analysismentioning

confidence: 99%

Intracoronary Autologous Cardiac Progenitor Cell Transfer in Patients With Hypoplastic Left Heart Syndrome

Ishigami

Ohtsuki

Tarui

et al. 2015

Circulation Research

165

141

View full text Add to dashboard Cite

show abstract

“…This is probably because the resultant circulation with a cavopulmonary shunt is more stable than a circulation in parallel, such as with the Norwood procedure, and ventricular function has been shown to be better after a volume unloading procedure [15,16].…”

Section: Discussionmentioning

confidence: 99%

Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome☆

Sakurai

Kado

Nakano

et al. 2009

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

Objective: To compare the haemodynamics and perioperative course of initial palliation with bilateral pulmonary artery banding (PAB) and the Norwood procedure. Methods: Between April 2004 and December 2007, 43 consecutive children with hypoplastic left heart syndrome (HLHS) or a variant underwent initial palliation (PAB, n = 18; Norwood, n = 25). Clinical perioperative data were analysed. In the PAB group, lipoprostaglandin E1 administration was continued with hospitalisation until stage 2 palliation with a bi-directional Glenn shunt and the Norwood procedure. Results: There were no significant differences in the age and operative weight of patients who received stage 1 palliation (PAB, 12 AE 9 days, 2.7 AE 0.6 kg; Norwood, 12 AE 8 days, 2.8 AE 0.4 kg). The PAB group had more high-risk patients than the Norwood group (PAB, 83%; Norwood, 48%, p = 0.04). Increased early and inter-stage mortality were observed in patients who underwent the Norwood procedure (early mortality with PAB, 6% vs Norwood, 12%; inter-stage mortality, 6% vs 27%, respectively). Mortality between stages 1 and 2 was 11% for the PAB group and 36% for the Norwood group. The Kaplan-Meier survival estimate at 1 year did not differ between groups (77% for the PAB group, 64% for the Norwood group). Ductal stenosis was found in one patient in the PAB group during the follow-up period. Twenty-eight patients underwent stage 2 reconstruction, and the patients in the PAB group were younger at the time of surgery (PAB, 116 days; Norwood, 224 days). There were no significant differences between groups in pulmonary artery index regarding body surface area (BSA) (PAB, 179 mm 2 BSA À1 ; Norwood, 194 mm 2 BSA À1 ) and the incidence of ventricular dysfunction after stage 2 construction (PAB, 21%; Norwood, 21%). Conclusions: Bilateral PAB with continuous lipo-prostaglandin E1 administration may improve early and intermediate mortality in infants with HLHS. Intimate care with hospitalisation may contribute to the results. #

show abstract

“…Die Vorteile bestehen darin, dass die Probleme einer pulmonalen Drucksteigerung und einer Volumenüberlastung des einzig verfügbaren Pumpventrikels deutlich reduziert und damit Anzahl und Schweregrad der einzelnen Risikofaktoren gesenkt werden konnten [37,76]. In einem zweiten Schritt erwartet diese Kinder nach 6-12 Monaten dann die komplette Fontanisierung mit deutlich verringertem Operationsrisiko.…”

Section: Choussat-kriterienunclassified

“…Eine verbesserte Patientenselektion während der letzten Dekade und die günstigere Wahl von Zeitpunkt und Art der einzelnen Operationsschritte führten zu einer Reduktion ungünstiger Prognosefaktoren, welche wesentlich durch die über längere Zeiträume bestehende Volumenüberlastung des Pumpventrikels bedingt wurden [50,63,74,76]. Bei den postoperativen Verlaufskontrollen nach Fontan-Prozedur fühlen sich die meisten Kinder, unabhängig davon, ob der Tunnel intraoder extrakardial verlegt worden ist, subjektiv wohl.…”

Section: Belastbarkeit Nach Fontan-operationunclassified

Entwicklung der Fontan-Prozedur als Behandlungskonzept für Kinder mit angeborenen komplexen Herzfehlern

Kuroczynski

2007

Herz

View full text Add to dashboard Cite

The spectrum of congenital heart defects reaches from very simple to extremely complex anomalies. 3 decades earlier, the prognosis of children with univentricular heart defects was poor. The Fontan procedure has been offered to patients with a variety of complex cyanotic heart diseases and has resulted in decreased mortality. This review summarizes the development and modifications of the Fontan procedure. The advances in preoperative, intraoperative und postoperative patient management have resulted in greatly improved survivals for even the most complex congenital defects. Over the past 3 decades, the survival of infants with critical congenital heart defects has increased to 90%.

show abstract

Bidirectional Glenn Procedure Improves the Mechanical Efficiency of a Total Cavopulmonary Connection in High-Risk Fontan Candidates

Abstract: The volume reduction of BDG preceding TCPC allows for any afterload mismatch to be corrected, thereby improving ventricular energetics after TCPC.

Cited by 119 publications

References 28 publications

Intracoronary Autologous Cardiac Progenitor Cell Transfer in Patients With Hypoplastic Left Heart Syndrome

Intracoronary Autologous Cardiac Progenitor Cell Transfer in Patients With Hypoplastic Left Heart Syndrome

Early results of bilateral pulmonary artery banding for hypoplastic left heart syndrome☆

Entwicklung der Fontan-Prozedur als Behandlungskonzept für Kinder mit angeborenen komplexen Herzfehlern

Contact Info

Product

Resources

About