Elevated Pulmonary Artery Pressure, Not Pulmonary Vascular Resistance, is an Independent Predictor of Short-Term Morbidity Following Bidirectional Cavopulmonary Connection

Tran, Susanna; Sullivan, Patrick M.; Cleveland, Jeanette N.; Kumar, S. Ram; Takao, Cheryl

doi:10.1007/s00246-018-1932-6

Cited by 11 publications

(6 citation statements)

References 16 publications

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“… 16 Although prior studies have noted a relationship between the intermediate term outcome hospital length of stay and certain clinical variables, such as lower weight, younger age, higher pulmonary artery pressure, and longer cardiopulmonary bypass time, risk factors and potential mechanisms for early intolerance of stage 2 circulation remain elusive. 3 , 16 , 17 , 18 , 19 In our study, we sought to address this gap by focusing on an immediate postoperative outcome, 48 hours hypoxemia burden, that we expected to be strongly tied to pulmonary vascular adequacy. Interestingly, we were not able to reproduce the relationship between the noted clinical variables and postoperative outcomes in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Increased Circulating Endothelin 1 Is Associated With Postoperative Hypoxemia in Infants With Single‐Ventricle Heart Disease Undergoing Superior Cavopulmonary Anastomosis

Frank

Khailová

Silveira

et al. 2022

JAHA

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Background Inadequate pulmonary vascular growth results in morbidity for many children with single‐ventricle heart disease (SVHD). Endothelin 1 (ET1) is a potent vasoconstrictor and stimulator of pulmonary artery smooth muscle proliferation. Circulating ET1 levels and their association with outcomes have not been studied during early SVHD palliation. We aimed to define circulating levels of ET1 in patients with SVHD undergoing stage 2 palliation and evaluate their relationship to postoperative hypoxemia. We hypothesized that patients with SVHD with higher ET1 concentration would have a greater post–stage 2 hypoxemia. Methods and Results Prospective cohort study of 55 subjects with SVHD undergoing stage 2 palliation and 50 controls. Samples for ET1 analysis were collected at preoperation (systemic and pulmonary vein) and 2, 24, and 48 hours postoperation for cases and a single time point for controls. The primary outcome was percentage of first 48 postoperative hours with clinically significant hypoxemia (saturation, <70%). ET1 concentration was lower in preoperative cases than controls (2.2 versus 2.7 pg/mL; P =0.0015) and in the pulmonary vein than systemic vein (1.7 versus 2.2 pg/mL; P <0.001). ET1 level increased by 2 hours postoperation and trended back to baseline by 48 hours. Higher preoperative pulmonary vein ET1 and 2 hours postoperative ET1 were associated with larger hypoxemia burden (10.6% versus 2.7% [ P =0.0081]; and 7.6% versus 3.2% [ P =0.01], respectively). Multivariable testing demonstrated ET1 concentration and cardiopulmonary bypass time were associated with hypoxemia, whereas catheterization measurements and clinical variables were not. Conclusions Infants with SVHD with higher perioperative ET1 concentration experience more post–stage 2 hypoxemia. ET1 activity may be a modifiable risk factor of pulmonary vascular inadequacy for stage 2 palliation.

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Section: Discussionmentioning

confidence: 99%

Increased Circulating Endothelin 1 Is Associated With Postoperative Hypoxemia in Infants With Single‐Ventricle Heart Disease Undergoing Superior Cavopulmonary Anastomosis

Frank

Khailová

Silveira

et al. 2022

JAHA

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“…At least five papers in English literature emphasize the elevated MPAP (>15 mmHg) as an important predictor of long‐term results in Fontan patients 14,18–21 . On the other hand, in a recent study of Tran and colleagues, elevated pulmonary artery pressure, not pulmonary vascular resistance (PVR) is reported to be associated with short‐term morbidity, in patients with bidirectional cavopulmonary connection 22 . In our preoperative evaluation, we did not routinely perform PVR calculation.…”

Section: Discussionmentioning

confidence: 98%

Fontan procedure in patients with preoperative mean pulmonary artery pressure over 15 mmHg

et al. 2021

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Background Several factors affect the long‐term outcome of Fontan procedure, but a high pulmonary artery pressure is still one of the most important limitation for proceeding to a Fontan circulation. Herein, we present our experience in Fontan patients with high preoperative pulmonary artery pressures. Methods A retrospective analysis was performed to evaluate Fontan patients with a preoperative pulmonary artery pressure >15 mmHg between 2009 and 2020. Sixteen patients were operated on with a mean preoperative pulmonary artery pressure of 17.5 ± 2.1 mmHg. Results Mean age at the time of Fontan procedure was 7.8 ± 5.6 years. All the patients had stage 2 cavopulmonary anastomosis before Fontan completion, with a mean interstage period of 4 ± 2.6 years. Fontan completion was achieved with a polytetrafluorethylene tubular conduit, two of which were intra‐extracardiac. Fenestration was performed in five (31%) cases. Postoperative pulmonary artery pressures and arterial oxygen saturation levels were 11.2 ± 2.8 and 97.8 ± 2 mmHg, respectively. Mean duration of pleural drainage was 3.9 ± 5.3 days. Any morbidity and mortality were not encountered during a mean follow‐up period of 4.8 ± 7.7 years. Conclusions The midterm results of stage 3 Fontan completion in patients with pulmonary artery >15 mmHg are encouraging. Not only the mean pulmonary artery pressure but also the pulmonary vascular resistance may be helpful in order to identify the high risk patients before Fontan completion.

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“…Additionally, left atrial hypertension can lead to pulmonary vascular changes and increased pulmonary artery pressure which is detrimental to the long-term outcome of patients with single ventricle palliation. 9 We sought to uncover if there were risks to NOT performing intra-HS1P ASI by comparing the groups' rate of complications such as NEC and ICU/hospital LOS. Fortunately, we found no differences in ICU or hospital LOS, complications, or readmissions between patients who had an intra-HS1P ASI versus those who did not.…”

Section: Discussionmentioning

confidence: 99%

Atrial septal interventions during and after hybrid stage I palliation of hypoplastic left heart syndrome

Thomas,

Sower,

Romano

et al. 2024

Cathet Cardio Intervent

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BackgroundHybrid stage I palliation (HS1P) is an alternative approach for initial palliation in hypoplastic left heart syndrome (HLHS) patients. Unlike surgical stage I palliation where atrial septectomy is routinely performed, atrial septal intervention (ASI) during HS1P is variable. In this study, we described our experience with ASI in single ventricle (SV) patients who underwent HS1P and identified factors associated with need for ASI after HS1P.MethodsData were retrospectively collected for all HLHS patients who underwent HS1P at our center over the past 12 years. We evaluated ASIs performed during the HS1P (intra‐HS1P ASI) and ASIs performed during the period from HS1P to the subsequent surgical stage, either interval Norwood stage I or comprehensive stage II (post‐HS1P ASI). Patient factors and procedural data were compared to identify factors associated with undergoing post‐HS1P ASI and the impact of ASI on patient outcomes was evaluated.ResultsOf 50 SV patients included, 23 (46%) underwent intra‐HS1P ASI and 26 (52%) underwent post‐HS1P ASI. Need for post‐HS1P ASI was lower among patients who had an intra‐HS1P ASI as compared to those who did not (30% vs. 70%; p = 0.005). There were no significant differences in short or Midterm outcomes between patients who underwent intra‐HS1P ASI or post‐HS1P ASI and their counterparts.ConclusionsASI is common both during and after HS1P but is generally well tolerated and type of ASI does not significantly impact overall patient outcomes. Our findings suggest that the current approach of individualizing management of ASI in the HS1P population is effective and safe.

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Elevated Pulmonary Artery Pressure, Not Pulmonary Vascular Resistance, is an Independent Predictor of Short-Term Morbidity Following Bidirectional Cavopulmonary Connection

Cited by 11 publications

References 16 publications

Increased Circulating Endothelin 1 Is Associated With Postoperative Hypoxemia in Infants With Single‐Ventricle Heart Disease Undergoing Superior Cavopulmonary Anastomosis

Increased Circulating Endothelin 1 Is Associated With Postoperative Hypoxemia in Infants With Single‐Ventricle Heart Disease Undergoing Superior Cavopulmonary Anastomosis

Fontan procedure in patients with preoperative mean pulmonary artery pressure over 15 mmHg

Atrial septal interventions during and after hybrid stage I palliation of hypoplastic left heart syndrome

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