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Risk factors for death or mechanical ventilation time after bidirectional cavopulmonary anastomosis in a developing

Marina C Jonas1, Fabio Carmona1, Luiz F Caneo2

  • 1Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Cardiology in the Young
|June 15, 2021
PubMed

Insights

The Glenn procedure, vital for cyanotic congenital heart disease, shows age at surgery, post-operative lactate, and low weight-for-age z-score as key risk factors for prolonged ventilation and death.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Critical Care Medicine

Background:

  • The Glenn procedure is a critical surgical intervention for patients with cyanotic congenital heart disease (CHD) and univentricular physiology.
  • This procedure boasts a high survival rate, exceeding 90%.

Purpose of the Study:

  • To identify and evaluate risk factors associated with adverse outcomes following the Glenn procedure.
  • The study aims to improve patient management and outcomes in this specific surgical context.

Main Methods:

  • A retrospective analysis of 97 patients who underwent the Glenn procedure between 2014 and 2019.
  • Data were sourced from the ASSIST initiative, a regional Brazilian registry of congenital heart surgeries.
  • Primary outcomes assessed included prolonged mechanical ventilation (>24 hours) and/or in-hospital death.

Main Results:

  • In-hospital mortality was 13.4%, with 52% of patients experiencing prolonged mechanical ventilation.
  • Cardiopulmonary bypass duration and post-operative lactate levels were identified as risk factors for combined adverse outcomes (death or prolonged ventilation).
  • Weight-for-age z-score and age at surgery were specifically linked to prolonged mechanical ventilation.

Conclusions:

  • Age at surgery, elevated post-operative lactate levels, and a low weight-for-age z-score are significant predictors of poor outcomes after the Glenn procedure.
  • These factors are associated with both prolonged mechanical ventilation and increased mortality.
  • Identifying these risk factors can aid in optimizing pre-operative and post-operative care for patients undergoing the Glenn procedure.
Abstract

Keywords:
CHDGlenn procedurebidirectional cavopulmonary anastomosisrisk factors

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