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Bidirectional Glenn Procedure in Patients Less Than 3 Months of Age: A 14-Year Experience
Melita Viegas1, Carlos E Diaz-Castrillon1, Mario Castro-Medina1
1Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Early stage 2 palliation (S2P) in single-ventricle patients is safe and effective. Performing S2P before 90 days of age leads to comparable Fontan completion rates without increased mortality.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Single Ventricle Physiology
Background:
- Contradictory data exist regarding the optimal timing for stage 2 palliation (S2P).
- Prolonged interstage hospitalization and home surveillance programs have accelerated the need for earlier S2P.
- This study describes the S2P population and examines the relationship between clinical outcomes and S2P timing over 14 years.
Purpose of the Study:
- To describe the characteristics of patients undergoing S2P.
- To explore the relationship between S2P timing and clinical outcomes, including Fontan completion, mortality, and transplantation rates.
- To evaluate the safety and efficacy of early S2P.
Main Methods:
- Retrospective analysis of 114 patients who underwent S2P between 2004 and 2018.
- Stratification of the analysis by S2P timing and clinical variables.
- Primary outcome: Fontan completion; Secondary outcomes: mortality and orthotopic heart transplantation rates.
Main Results:
- Median age at S2P was 100 days; early S2P group median age was 79 days.
- Overall Fontan completion rate was 76%, with no significant difference between early and non-early S2P groups.
- No operative mortalities and no significant differences in late mortality rates were observed.
Conclusions:
- The interstage period remains high-risk for single-ventricle palliation patients.
- S2P performed before 90 days of age is a safe and viable option when clinically indicated.
- Early S2P results in comparable Fontan completion rates to later S2P.
Background:
Contradictory data exist regarding timing of stage 2 palliation (S2P). Prolonged interstage hospitalizations and home surveillance programs have contributed to a more rapid progression to S2P. Our goal is to describe the S2P population and explore the relationships of clinical outcomes and S2P timing at our institution over the last 14 years.
Methods:
S2P procedures from 2004 to 2018 at a single institution were included in a retrospective analysis. The analysis was stratified by S2P timing and clinical variables. The primary outcome was Fontan completion, and secondary outcomes included mortality and orthotopic heart transplantation rate, as well as perioperative clinical variables.
Results:
A total of 114 patients who underwent S2P were included. The median age and weight at S2P were 100 days (interquartile range [IQR], 87-119) and 5.1 (IQR, 4.6-5.5) kg, respectively. The median age in the early group was 79 (IQR, 73-87) days and in the nonearly group was 107 (IQR, 100-124) days. Ninety percent of cavopulmonary anastomoses were augmented with an ePTFE (expanded polytetrafluoroethylene) patch. The overall Fontan completion rate was 76%, without differences in Kaplan-Meier estimates. There were no operative mortalities and no differences in late mortality rate (P = .30).
Conclusions:
The interstage period continues to be high risk for those undergoing single-ventricle palliation. In our experience, S2P performed at less than 90 days seems to be a viable and safe procedure when indicated, resulting in comparable Fontan completion rates.
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