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Identification of patient variables that are associated with ventricular end-diastolic pressure before the
Matthew C Schwartz1,2, Aravinth Karunanandaa2, William E Anderson3
1Sanger Heart and Vascular Institute, Charlotte, NC, USA.
Insights
Systemic ventricular end-diastolic pressure is crucial in single ventricle heart disease. Elevated pressure before bidirectional Glenn operation is linked to a systemic right ventricle and predicts worse outcomes after Fontan operation.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Physiology
Background:
- Systemic ventricular end-diastolic pressure is a critical hemodynamic parameter in single ventricle heart disease.
- Identifying predictors of elevated systemic ventricular end-diastolic pressure before the bidirectional Glenn operation is essential for patient management.
Purpose of the Study:
- To identify predictors of elevated systemic ventricular end-diastolic pressure prior to bidirectional Glenn operation.
- To assess the prognostic value of pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure in patients with single ventricle physiology.
Main Methods:
- Retrospective review of 100 patients undergoing bidirectional Glenn operation between 2007 and 2017.
- Extraction of pre-operative and post-Fontan variables for analysis.
Main Results:
- Higher systemic ventricular end-diastolic pressure was observed in patients with a systemic right ventricle compared to a systemic left ventricle (9.1 vs 7.7 mmHg).
- Pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure was positively associated with systemic right ventricle, history of recoarctation, Norwood operation, and ventricular systolic pressure.
- Elevated pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure predicted adverse outcomes, including death, transplantation, or heart failure symptoms, after Fontan operation.
Conclusions:
- Systemic ventricular end-diastolic pressure is a significant predictor of outcomes in single ventricle patients.
- The pre-bidirectional Glenn operation state may reveal diastolic dysfunction with prognostic implications.
- A systemic right ventricle and higher ventricular systolic pressure are key predictors of elevated systemic ventricular end-diastolic pressure.
Introduction:
Systemic ventricular end-diastolic pressure is important in patients with single ventricle heart disease. Predictors of an elevated systemic ventricular end-diastolic pressure prior to bidirectional Glenn operation have been incompletely identified.
Methods:
All patients who underwent bidirectional Glenn operation operation at our centre between January 2007 and March 2017 were retrospectively identified and patient variables were extracted. For patients who had undergone Fontan operation at the time of this study, post-Fontan patient variables were also extracted.
Results:
One-hundred patients were included with a median age at pre-bidirectional Glenn operation catheterisation of 4.5 months. In total, 71 (71%) patients had a systemic right ventricle. At the pre-bidirectional Glenn operation catheterisation, the mean systemic ventricular end-diastolic pressure was higher amongst those with systemic right ventricle compared to left ventricle (9.1 mmHg ± 2.1 versus 7.7 ± 2.7 mmHg, p < 0.01). On univariate analysis, pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01), history of recoarctation (p = 0.03), history of Norwood operation (p = 0.04), and ventricular systolic pressure (p < 0.01). On multivariate analysis, systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01) and ventricular systolic pressure (p < 0.01). Amongst those who had undergone Fontan operation at the time of study (n = 49), those with a higher pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure were more likely to have experienced death, transplantation, or listed for transplantation (p = 0.02) and more likely to have had heart failure symptoms (p = 0.04) at a mean time from Fontan of 5.2 years ± 1.3.
Conclusions:
In patients undergoing bidirectional Glenn operation operation, the volume-loaded, pre-bidirectional Glenn operation state may expose diastolic dysfunction that has prognostic value.
