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The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality.
Brian E Kogon1, Courtney Plattner, Traci Leong
1Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA. Brian_kogon@emoryhealthcare.org
The Journal of Thoracic and Cardiovascular Surgery
|November 26, 2008
Summary
This study identified risk factors for morbidity after the bidirectional Glenn operation, finding that prolonged bypass time and elevated pressures adversely affected outcomes. Patient outcomes were not negatively impacted by a persistent left superior vena cava.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Single ventricle heart defects necessitate palliative surgical interventions like the bidirectional Glenn operation.
- Assessing risk factors for morbidity and mortality is crucial for optimizing surgical outcomes in these complex patients.
Purpose of the Study:
- To analyze risk factors associated with morbidity and mortality following the bidirectional Glenn operation.
- To evaluate the impact of a persistent left superior vena cava on surgical outcomes by comparing unilateral and bilateral Glenn procedures.
Main Methods:
- Retrospective review of 270 patients undergoing bidirectional Glenn operation (2001-2007).
- Analysis of patient characteristics, operative details, and postoperative outcomes including drainage duration, ICU/hospital stay, morbidity, and mortality.
- Comparison of outcomes between unilateral (n=226) and bilateral (n=44) operations, including assessment of persistent left superior vena cava effects.
Main Results:
- Prolonged cardiopulmonary bypass time, elevated central venous pressure, and transpulmonary gradient were risk factors for adverse outcomes.
- Right ventricular morphology was also associated with increased morbidity.
- Mortality was low (0.7%), with no identified risk factors; outcomes were not significantly different between unilateral and bilateral Glenn groups, irrespective of left superior vena cava presence.
Conclusions:
- Key factors impacting outcomes after bidirectional Glenn operation include prolonged cardiopulmonary bypass, elevated central venous pressure, transpulmonary gradient, and right ventricular morphology.
- The presence of a persistent left superior vena cava did not adversely affect postoperative outcomes.
- Surgical approach (unilateral vs. bilateral) did not yield significant differences in postoperative outcomes.
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