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A complicated Glenn procedure: risk factors and association with adverse long-term neurodevelopmental and functional
Gurpreet K Khaira1,2, Ari R Joffe1,2, Gonzalo G Guerra1,2,3
1Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Insights
Complicated Glenn procedures (cGP) were linked to higher post-operative inotrope scores and inhaled nitric oxide use. A cGP also predicted poorer neurodevelopmental and functional outcomes in children at 2 years old.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Neurodevelopmental Outcomes
Background:
- The Glenn procedure is a critical palliative surgery for single-ventricle congenital heart defects.
- Complications following the Glenn procedure can significantly impact long-term patient health.
- Identifying risk factors and outcomes associated with complicated Glenn procedures (cGP) is essential for improving patient care.
Purpose of the Study:
- To identify potentially modifiable risk factors for a complicated Glenn procedure (cGP).
- To investigate whether a cGP predicts adverse neurodevelopmental and functional outcomes at 2 years of age.
Main Methods:
- A cohort of 169 patients undergoing the Glenn procedure between 2012 and 2017 was analyzed.
- Neurodevelopmental assessments using the Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) and Adaptive Behavior Assessment System-2nd Edition (ABAS-II) were conducted at age 2 in survivors.
- Statistical analyses included univariate and multiple variable linear or Cox regressions to determine predictors of outcomes.
Main Results:
- 16% of patients experienced a complicated Glenn procedure (cGP).
- Higher inotrope score on post-operative day 1 and use of inhaled nitric oxide were significantly associated with cGP.
- A cGP was independently associated with significantly lower Bayley-III Cognitive and Language scores, and lower General Adaptive Composite (GAC) scores from the ABAS-II.
Conclusions:
- Post-operative inotropic support and inhaled nitric oxide are associated with an increased risk of complicated Glenn procedures.
- Complicated Glenn procedures are independently linked to adverse neurodevelopmental and functional outcomes at 2 years of age.
- Further research is warranted to explore early recognition and intervention strategies for preventing adverse outcomes in at-risk patients.
Objectives:
To determine potentially modifiable risk factors for a complicated Glenn procedure (cGP) and whether a cGP predicted adverse neurodevelopmental and functional outcomes. A cGP was defined as post-operative death, heart transplant, extracorporeal life support, Glenn takedown, or prolonged ventilation.
Methods:
All 169 patients having a Glenn procedure from 2012 to 2017 were included. Neurodevelopmental assessments were performed at age 2 years in consenting survivors (n = 156/159 survivors). The Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) and the Adaptive Behavior Assessment System-2nd Edition (ABAS-II) were administered. Adaptive functional outcomes were determined by the General Adaptive Composite (GAC) score from the ABAS-II. Predictors of outcomes were determined using univariate and multiple variable linear or Cox regressions.
Results:
Of patients who had a Glenn procedure, 10/169 (6%) died by 2 years of age and 27/169 (16%) had a cGP. Variables statistically significantly associated with a cGP were the inotrope score on post-operative day 1 (HR 1.04, 95%CI 1.01, 1.06; p = 0.010) and use of inhaled nitric oxide post-operatively (HR 7.31, 95%CI 3.19, 16.76; p < 0.001). A cGP was independently statistically significantly associated with adverse Bayley-III Cognitive (ES -10.60, 95%CI -17.09, -4.11; p = 0.002) and Language (ES -11.43, 95%CI -19.25, -3.60; p = 0.004) scores and adverse GAC score (ES -14.89, 95%CI -22.86, -6.92; p < 0.001).
Conclusions:
Higher inotrope score and inhaled nitric oxide used post-operatively were associated with a cGP. A cGP was independently associated with adverse 2-year neurodevelopmental and functional outcomes. Whether early recognition and intervention for risk of a cGP can prevent adverse outcomes warrants study.
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