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Risk factors for death or mechanical ventilation time after bidirectional cavopulmonary anastomosis in a developing country

Part of: Surgery

Published online by Cambridge University Press:  15 June 2021

Marina C. Jonas
Affiliation:
Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
Fabio Carmona
Affiliation:
Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
Luiz F. Caneo
Affiliation:
Division of Cardiovascular Surgery. Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Aida L. R. Turquetto
Affiliation:
Division of Cardiovascular Surgery. Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Marcelo B. Jatene
Affiliation:
Division of Cardiovascular Surgery. Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
Paulo H. Manso*
Affiliation:
Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
*
Author for correspondence: Paulo H. Manso, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900. Ribeirao Preto, SP 14049-900 Brazil. Tel: +55-16-39633017; Fax: +55 16 36022700. E-mail: phmanso@fmrp.uspbr

Abstract

Background:

Glenn procedure is performed for patients with cyanotic CHD and univentricular physiology and has a survival rate above 90%.

Aim:

To evaluate the risk factors associated with a poor outcome after Glenn procedure.

Methods:

The data for this retrospective analysis were collected from a regional Brazilian registry of congenital heart surgeries (ASSIST initiative) from 2014 to 2019. Data from 97 patients who underwent the Glenn procedure were considered. The primary outcomes were prolonged mechanical ventilation (>24 hours post-operatively) or in-hospital death, alone and combined.

Results:

The overall in-hospital mortality was 13.4% (n = 13). Prolonged mechanical ventilation occurred in 52% (n = 51) of the patients. Our analysis found that risk factors for death or prolonged post-operative mechanical ventilation were cardiopulmonary bypass duration and post-operative lactate, whereas weight-for-age z-score and age at surgery were risk factors for prolonged mechanical ventilation. Cardiopulmonary bypass duration increased (adjusted odds ratio: 1.02; 95 % CI: 1.01, 1.03) and age at surgery decreased (adjusted odds ratio: 0.96; 95 % CI: 0.93, 0.99) the odds of the combined outcome.

Conclusions:

Age at surgery, post-operative lactate, and low-weight-for-age z-score are associated with prolonged mechanical ventilation and death following the Glenn procedure.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Tanoue, Y, Kado, H, Boku, N, et al. Article in press Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute. Interact Cardiovasc Thorac Surg 2007; 6: 97101.CrossRefGoogle Scholar
Herrmann, JL, Brown, JW. The superior cavopulmonary connection: history and current perspectives. World J Pediatr Congenit Heart Surg 2019; 10: 216222.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377381. doi: 10.1016/j.jbi.2008.08.010.CrossRefGoogle ScholarPubMed
Carmona, F, Manso, PH, Ferreira, MN, et al. Collaborative quality improvement in the congenital heart defects: development of the assist consortium and a preliminary surgical outcomes report. Braz J Cardiovasc Surg 2017; 32: 260269.Google Scholar
Norwood, WI, Jacobs, ML. Fontan’s procedure in two stages. Am J Surg 1993; 166: 548551.CrossRefGoogle ScholarPubMed
Manuel, V, Morais, H, Turquetto, ALR, et al. Single ventricle palliation in a developing sub-Saharan African country: what should be improved? World J Pediatr Congenit Heart Surg 2019; 10: 164170.CrossRefGoogle Scholar
Kogon, BE, Plattner, C, Leong, T, Simsic, J, Kirshbom, PM, Kanter, KR. The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg 2008; 136: 12371242. doi: 10.1016/j.jtcvs.2008.05.017.CrossRefGoogle ScholarPubMed
François, K, Vandekerckhove, K, De Groote, K, Panzer, J, De Wolf, D, De Wilde, H, et al. Current outcomes of the bi-directional cavopulmonary anastomosis in single ventricle patients: analysis of risk factors for morbidity and mortality, and suitability for Fontan completion. Cardiol Young 2015; 26: 288297.CrossRefGoogle ScholarPubMed
Nichay, NR, Gorbatykh, YN, Kornilov, IA, et al. Risk factors for unfavorable outcomes after bidirectional cavopulmonary anastomosis. World J Pediatr Congenit Heart Surg 2017; 8: 575583. Available from: http://journals.sagepub.com/. doi: 10.1177/2150135117728505.CrossRefGoogle ScholarPubMed
Schidlow, DN, Gauvreau, K, Cherian, KM, et al. Single-ventricle palliation in low- and middle-income countries. J Am Coll Cardiol 2019; 74: 928931.CrossRefGoogle ScholarPubMed
Silvilairat, S, Pongprot, Y, Sittiwangkul, R, Woragidpoonpol, S, Chuaratanaphong, S, Nawarawong, W. Factors influencing survival in patients after bidirectional Glenn shunt. Asian Cardiovasc Thorac Ann 2008; 16: 381386.CrossRefGoogle ScholarPubMed
Jonas, MC, Ramalho, FS, Vicente, WV, Manso, PH. Superior vena cava obstruction after the Glenn procedure. Autops Case Rep 2019; 9: 13.CrossRefGoogle ScholarPubMed
Cleveland, JD, Tran, S, Takao, C, Wells, WJ, Starnes, VA, Kumar, SR. Need for pulmonary arterioplasty during Glenn independently predicts inferior surgical outcome. Ann Thorac Surg 2018; 106: 156164.CrossRefGoogle ScholarPubMed
Hamamoto, M, Uemura, H, Imanaka, H, Yagihara, T. Relevance of the measurement of the concentration of lactate in the serum subsequent to the Fontan procedure in small children. Cardiol Young 2006; 16: 275280.CrossRefGoogle Scholar