Preoperative single ventricle function determines early outcome after second-stage palliation of single ventricle heart

Abstract

BackgroundSecond-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures.Material and methodsWe analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications.ResultsThe patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures.ConclusionSignificant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures.

Single Ventricle Palliation in a Developing Sub-Saharan African Country: What Should be Improved?

“…Several studies have reported >70% survival rates. [6][7][8][9][10][11][12][13] In contrast, operative mortality was very high in this study. Most of the deaths in our study occurred during hospitalization at stage I, mainly in patients who underwent BTS.…”

“…1,3,4 Single ventricle physiology, one of the main complex CHD types, requires early detection and referral to a pediatric cardiac center. 6,7 The surgical treatment of these patients usually requires more than two palliative procedures.…”

“…7 Several studies conducted in middle-and high-income countries measured survival in single ventricle palliation and reported a survival >70% after more than 15 years of follow-up. [6][7][8][9][10][11][12][13] In low-income countries, information is lacking regarding the management of single ventricle palliation. 5,11,14 The aim of this study was to report the outcomes, survival, and management challenges of single ventricle patients in the context of a new sub-Saharan African cardiothoracic center.…”

“…Several studies conducted in middle- and high-income countries measured survival in single ventricle palliation and reported a survival >70% after more than 15 years of follow-up. 6 -13…”

Highlights of Current Research in Congenital Heart Disease: Presenting Abstracts From the 2019 Congenital Cardiac Anesthesia Society (CCAS) Annual Meeting

“…8 Recent studies have investigated the impact of single patient factors on survival, including nutritional status, lower birth weight, weight at surgery, ventricular dominance, Blalock-Taussig shunt versus right ventriculotomy for right ventricular to pulmonary artery shunt, shunt fraction, ventricular function, hybrid versus Norwood procedure, genetic abnormality, extracorporeal membrane oxygenation, and open sternum on the day of the Norwood procedure. [9][10][11][12][13][14][15] Patient factors, however, are not solitary but coexist in a complex interplay that affects survival. Do et al utilized a neural network to identify multiple factors together that are predictive of 1-year survival.…”