Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand

Sethasathien, Saviga; Silvilairat, Suchaya; Lhodamrongrat, Chayaporn; Sittiwangkul, Rekwan; Makonkawkeyoon, Krit; Pongprot, Yupada; Borisuthipandit, Thirasak; Woragidpoonpol, Surin

doi:10.1007/s11748-020-01461-9

Cited by 2 publications

(5 citation statements)

References 27 publications

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“…Sinha and associates found that concomitant atrioventricular valve repair was associated with worse outcomes after the staged repair of single ventricles, but that was not the case in our study [ 18 ]. Similar to our series, Sethasathien, and associates found that high preoperative mean pulmonary artery pressure was an independent predictor of mortality after BDG shunt [ 15 ]. On the other hand, Silvilairat and colleagues found no effect of pulmonary artery pressure on mortality after BDG shunt [ 19 ].…”

Section: Discussionsupporting

confidence: 89%

“…The mortality rate reported after BDG shunt varies widely in the literature. Meyer and associates reported a 3.3% mortality rate among 61 children [11], and other series reported a mortality rate between 1 and 20% after BDG shunt [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…The atrioventricular valve was competent in 102 patients (43.40%), and 6 had severe regurgitation (2.55%). Preoperative saturation was 86% (80-91), and the mean pulmonary artery pressure was 14 (11)(12)(13)(14)(15)(16)(17)(18) mmHg. (Table 1).…”

Section: Patients' Characteristicsmentioning

confidence: 99%

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Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center

et al. 2023

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center

et al. 2023

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“…3 The Glenn procedure is the second stage of correction, [4][5][6] and its success or failure have been associated with various factors, including atrioventricular valve regurgitation, pre-operative mean pulmonary artery pressure, pre-operative PVRi, post-operative mean pulmonary artery pressure and diaphragmatic paralysis. 7 Inflammatory activity is expected to develop after surgery and is necessary for healing; however, the complexity of the procedures and the sheer number of required manipulations may lead to excessive inflammation-which has been demonstrated to be associated with adverse in-hospital outcomes. 8 Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume have emerged as novel, easily accessible markers of systemic inflammation.…”

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confidence: 99%

“…Ukil Isildak and Y. Yavuz 12 In another study by Sethasathien and colleagues, atrioventricular valve regurgitation, pre-operative mean pulmonary artery pressure of ≥17 mmHg, pre-operative PVRi of ≥3.1 Wood Units/m 2 were found to be associated with early mortality. 7 The neutrophil-to-lymphocyte ratio value has been accepted as a novel marker of systemic inflammation. Accumulating data indicate that neutrophil-to-lymphocyte ratio has a close relation with worse outcomes in patients with cardiovascular disorders including arterial stiffness, hypertension, acute coronary syndrome, coronary artery disease burden, percutaneous coronary intervention and heart failure.…”

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confidence: 99%

The role of neutrophil-to-lymphocyte ratio in predicting mortality after bidirectional Glenn procedure

Işıldak

Yavuz

2022

Cardiol Young

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This study aimed to address the role of various inflammation-related blood indices for the assessment of in-hospital outcomes in subjects undergoing Glenn procedure. Subjects who underwent the Glenn procedure for hypoplastic left heart syndrome were analysed retrospectively. Subjects were divided into two groups: Group 1 consisted of 78 patients who were discharged, and Group 2 included 12 patients who died after surgery. Post-operative third-day neutrophil count and neutrophil-to-lymphocyte ratio value were significantly higher in the exitus group compared to the discharged group (p = 0.006 and p = 0.003, respectively). Third-day neutrophil-to-lymphocyte ratio was positively correlated with duration of intubation (r = 0.253, p = 0.018), length of stay in ICU (r = 0.296, p = 0.006) and length of hospital stay (r = 0.297, p = 0.005). Multiple logistic regression analysis revealed that patients with high third-day neutrophil-to-lymphocyte ratio (≥6) had 14.227-fold higher risk of death compared to those with lower values. In addition, higher pulmonary arterial pressure was associated with increased risk of death. Receiver operating characteristics analysis revealed that neutrophil-to-lymphocyte ratio had 66.67% sensitivity, 84% specificity, 81.61% accuracy, 40.00% positive predictive value and 94.03% negative predictive value with a cut-off point of ≥6 to predict mortality. Third-day neutrophil-to-lymphocyte ratio and increased post-operative pulmonary arterial pressure are significant predictors for in-hospital mortality in Glenn procedure recipients. A cut-off value of ≥6 for third-day neutrophil-to-lymphocyte ratio predicts mortality with 66.67% sensitivity and 84% specificity. Given its simplicity and availability, post-operative neutrophil-to-lymphocyte ratio should be monitored on a daily basis to identify patients with high risk for mortality after Glenn procedure.

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Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand

Cited by 2 publications

References 27 publications

Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center

Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center

The role of neutrophil-to-lymphocyte ratio in predicting mortality after bidirectional Glenn procedure

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