Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Sughimoto, Koichi; Zannino, Diana; Mathew, Jacob; Weintraub, Robert G.; d’Udekem, Yves; Konstantinov, Igor E.

doi:10.1016/j.athoracsur.2015.05.041

Cited by 9 publications

(19 citation statements)

References 15 publications

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“…Most groups have found comparable overall mortality between patients with APBF and those without . Of note, most cohorts found in the literature had a mixed source of APBF . Given the findings of this study, this approach could represent a feasible temporary alternative for single ventricle patients in challenging circumstances given the relatively low incidence of complications and mortality, the latter which is comparable to the results of previous PG cohorts and BDG cohorts .…”

Section: Discussionsupporting

confidence: 72%

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Pulsatile Glenn as long-term palliation for single ventricle physiology patients

Chacón-Portillo

Zhu

Dickerson

et al. 2018

Congenital Heart Disease

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Objective There are limited studies analyzing pulsatile Glenn as a long‐term palliation strategy for single ventricle patients. This study sought to determine their outcomes at a single institution. Design A retrospective review was performed. Setting Study performed at a single pediatric hospital. Patients All single ventricle patients who underwent pulsatile Glenn from 1995 to 2016 were included. Outcome measures Pulsatile Glenn failure was defined as takedown, transplant, or death. Further palliation was defined as Fontan, 1.5, or biventricular repair. Risk factors were assessed by Cox multivariable competing risk analyses. Results Seventy‐eight patients underwent pulsatile Glenn at age 9 months (interquartile range, 5‐14). In total, 28% had heterotaxy, 18% had a genetic syndrome, and 24% had an abnormal inferior vena cava. There were 3 (4%) perioperative mortalities. Further palliation was performed in 41 (53%) patients with a median time‐to‐palliation of 4 years (interquartile range, 3‐5). Pulsatile Glenn failure occurred in 10 (13%) patients with 8 total mortalities. Five‐ and 10‐year transplant‐free survival were 91% and 84%, respectively. At a median follow‐up of 6 years (interquartile range, 2‐8), 27 patients (35%) remained with PG (age 7 years [interquartile range, 3‐11], oxygen saturation 83% ± 4%). Preoperative moderate‐severe atrioventricular valve regurgitation (AVVR) (hazard ratio 7.77; 95% confidence interval 1.80‐33.43; P =.005) and higher pulmonary vascular resistance (hazard ratio 2.59; 95% confidence interval 1.08‐6.15; P =.031) were predictors of pulsatile Glenn failure after adjusting for covariates. Reaching further palliation was less likely in patients with preoperative moderate‐severe AVVR (hazard ratio 0.22, 95% confidence interval 0.08‐0.59; P =.002). Conclusion Pulsatile Glenn can be an effective tool to be used in challenging circumstances, these patients can have a favorable long‐term prognosis without reducing their suitability for further palliation.

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Section: Discussionsupporting

confidence: 72%

“…Previous groups have attempted to determine how APBF influences late and overall mortality compared to BDG. Most groups have found comparable overall mortality between patients with APBF and those without . Of note, most cohorts found in the literature had a mixed source of APBF .…”

Section: Discussionmentioning

confidence: 98%

Pulsatile Glenn as long-term palliation for single ventricle physiology patients

Chacón-Portillo

Zhu

Dickerson

et al. 2018

Congenital Heart Disease

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“…Unfortunately, little data is available on the effects of BCPS with APBF on the Fontan circulation. Sugimoto and colleagues reported that patients who underwent BCPS with APBF had better-developed PA prior to the Fontan procedure, shorter pleural drainage duration, and shorter hospital stay after the Fontan procedure [25]. In our study, PA developed well and PAI was maintained at 485.…”

Section: Discussionsupporting

confidence: 58%

Long-term Results of Additional Pulmonary Blood Flow With Bidirectional Cavopulmonary Shunt

Kowatari

Suzuki

Daitoku

et al. 2020

Preprint

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Objective: We evaluatedadditional pulmonary blood flowat the time of bidirectional cavopulmonary shunt andits effectson the Fontan procedure andlong-term outcome of Fontan circulation and liver function.Methods: We included 22patients (16 boys, 6 girls) having undergonebidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean ageand body weight were 20 ±13 monthsand 7.5 ± 6.5 kg, respectively.We retrospectively evaluated the patients'clinical data,including cardiac catheterization data, liver function, and liver fibrosis markers.Results: All patients werealive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following:the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p<0.001);systemic ventricle end-diastolic pressure decreased from 11.4±3.2 mmHg to 6.9±3.6mmHg(p<0.001);and the pulmonary artery index decreased from 485.1±272.3 to 269.5 ± 100.5(p=0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure.Conclusions:The additional pulmonary blood flowat the time of bidirectional cavopulmonary shuntmaycontributeto pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistanceand without ventricle volumeoverload. The Fontan circulation was well-maintained at thelong-term follow-up, while liver fibrosis markerswere above their normal values.

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“…The potential benefits of APBF has been a topic of debate. Even though this strategy may be beneficial [19], some investigators [20,21] have already reported a higher incidence of chylothorax in patients who underwent SCPC when keeping APBF. Once again, the rise in central venous pressure by the forward flow would explain this phenomenon.…”

Section: Commentmentioning

confidence: 99%

Patients With Systemic Right Ventricle Are at Higher Risk of Chylothorax After Cavopulmonary Connections

Soquet

Mufti

Jones

et al. 2018

The Annals of Thoracic Surgery

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Forward Flow Through the Pulmonary Valve After Bidirectional Cavopulmonary Shunt Benefits Patients at Fontan Operation

Cited by 9 publications

References 15 publications

Pulsatile Glenn as long-term palliation for single ventricle physiology patients

Pulsatile Glenn as long-term palliation for single ventricle physiology patients

Long-term Results of Additional Pulmonary Blood Flow With Bidirectional Cavopulmonary Shunt

Patients With Systemic Right Ventricle Are at Higher Risk of Chylothorax After Cavopulmonary Connections

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