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Yousef AA, Elmahrouk AF, Hamouda TE, Helal AM, Dohain AM, Alama A, Shihata MS, Al-Radi OO, Jamjoom AA, Mashali MH. Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center. Egypt Heart J 2023; 75:53. [PMID: 37378691 DOI: 10.1186/s43044-023-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite the improved management of patients with a single ventricle, the long-term outcomes are not optimal. We reported the outcomes of the bidirectional Glenn procedure (BDG) and factors affecting the length of hospital stay, operative mortality, and Nakata index before Fontan completion. RESULTS This retrospective study included 259 patients who underwent BDG shunt from 2002 to 2020. The primary study outcomes were operative mortality, duration of hospital stay, and Nakata index before Fontan. Mortality occurred in 10 patients after BDG shunt (3.86%). By univariable logistic regression analysis, postoperative mortality after BDG shunt was associated with high preoperative mean pulmonary artery pressure (OR: 1.06 (95% CI 1.01-1.23); P = 0.02). The median duration of hospital stay after BDG shunt was 12 (9-19) days. Multivariable analysis indicated that Norwood palliation before BDG shunt was significantly associated with prolonged hospital stay (β: 0.53 (95% CI 0.12-0.95), P = 0.01). Fontan completion was performed in 144 patients (50.03%), and the pre-Fontan Nataka index was 173 (130.92-225.34) mm2/m2. Norwood palliation (β: - 0.61 (95% CI 62.63-20.18), P = 0.003) and preoperative saturation (β: - 2.38 (95% CI - 4.49-0.26), P = 0.03) were inversely associated with pre-Fontan Nakata index in patients who had Fontan completion. CONCLUSIONS BDG had a low mortality rate. Pulmonary artery pressure, Norwood palliation, cardiopulmonary bypass time, and pre-BDG shunt saturation were key factors associated with post-BDG outcomes in our series.
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Affiliation(s)
- Aly A Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Abdelmonem M Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhadi Alama
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohammad S Shihata
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiac Surgery Section, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohamed H Mashali
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Bellsham-Revell HR, Tarmahomed A, Chou C, Wong J, Mathur S, Vigneswaran T, Salih C. Early superior cavopulmonary connection with pre-operative CT shows comparable outcomes for infants following norwood palliation. Eur J Cardiothorac Surg 2022; 62:6594490. [PMID: 35640135 DOI: 10.1093/ejcts/ezac324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There is increasing evidence that performing superior cavopulmonary connection at 3 months reduces mortality: reducing the risky 'interstage' period, volume off-loading the ventricle and reducing coronary steal, hopefully preserving ventricular function. Our objective was to describe our experience of early superior cavopulmonary connection with preoperative CT assessment compared to later connection at 6 months. METHODS Patients undergoing Norwood procedure from 2005 to 2020 were divided into Two eras were described and compared. Era 1 from 2005-2016 when superior cavopulmonary connection was undertaken at 6 months: and era 2 (2017-2020) when an earlier operation was performed. Demographics, mortality (interstage, early and late following superior cavopulmonary connection) and data on post-operative course and complications were recorded. RESULTS In era 1, 191 patients underwent Norwood (120 survivors to superior cavopulmonary connection) and 28 patients (23 survivors) in era 2. There were no significant differences in the demographics. Interstage mortality was 17.8% in era 1 and 8.0% in era 2 but not significantly significant (p = 0.22). The median (IQR) age at pre-imaging and superior cavopulmonary connection was significantly lower: 99 (81-120) vs 77 (47-102) days and 175 (117-208) vs 106 (102-122) day in era 1 vs era 2 (P < 0.005). Weight was lower at superior cavopulmonary connection in era 2 (mean (SD) 6.2 kg (1.2) vs 5.1 kg (0.8), p < 0.05). Intubation time and total length of stay were not statistically different. Median Intensive care unit stay was statistically significantly longer, but not clinically significant): 2.5 (2-4) vs 3 (3-5) days respectively (p < 0.05). There was no significant difference in early or late mortality, rates of diagnostic or interventional catheter, post-operative MRI/CT or stroke. Logistic regression analysis demonstrates increasing age at superior cavopulmonary connection was associated with increased chance of stroke or early death (p = 0.043). CONCLUSIONS Early superior cavopulmonary connection with CT assessment is feasible and although intensive care unit length of stay was slightly longer there was no change in the overall length of stay and no change in post-operative mortality or complications.
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Affiliation(s)
| | - Abdulla Tarmahomed
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Catie Chou
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - James Wong
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Trisha Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - Caner Salih
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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