BACKGROUND: Outcomes of patients undergoing cavopulmonary palliation for single ventricle physiology may be impacted by living at altitude, as the passive pulmonary circulation is dependent on the resistance of the pulmonary vascular bed. The objective of this study is to identify risk factors for failure of cavopulmonary palliation at elevated altitude. METHODS AND RESULTS: Between January 1995 and March 2007, 122 consecutive patients living at a mean altitude of 1600 m (range 305 to 2570) underwent a bidirectional Glenn (BDG). There was one in-hospital mortality and 7 late deaths. 52 have proceeded to the Fontan procedure. Survival after BDG was 92.4% at 5 years. Freedom from palliation failure, defined as death, transplant, BDG/Fontan takedown, or revision was 81% at 5 years. At a mean follow-up of 39.8 months, 90 patients (75%) were in New York Heart Association class I. Patients with failing cavopulmonary circulation had higher pre-BDG pulmonary artery pressure (PAP) (18.3+/-6.1 mm Hg versus 14.8+/-5.1 mm Hg, P=0.016) and higher pre-BDG transpulmonary gradient (TPG) (11.2+/-6.2 mm Hg versus 7.7+/-4.3 mm Hg, P=0.014). Post-BDG, patients with palliation failure had increased PAP (15.0+/-5.7 mm Hg versus 10.8+/-2.8 mm Hg, P=0.008) and indexed pulmonary vascular resistance (PVRI) (2.43+/-1.0 Wood U . m(2) versus 1.52+/-0.9 Wood U . m(2), P=0.007). CONCLUSIONS: The majority of patients at moderate altitude have favorable outcomes after BDG or Fontan palliation. Risk factors for palliation failure at elevated altitude include PAP >15 mm Hg, TPG >8 mm Hg, and PVRI >2.5 Wood U . m(2).
BACKGROUND: Outcomes of patients undergoing cavopulmonary palliation for single ventricle physiology may be impacted by living at altitude, as the passive pulmonary circulation is dependent on the resistance of the pulmonary vascular bed. The objective of this study is to identify risk factors for failure of cavopulmonary palliation at elevated altitude. METHODS AND RESULTS: Between January 1995 and March 2007, 122 consecutive patients living at a mean altitude of 1600 m (range 305 to 2570) underwent a bidirectional Glenn (BDG). There was one in-hospital mortality and 7 late deaths. 52 have proceeded to the Fontan procedure. Survival after BDG was 92.4% at 5 years. Freedom from palliation failure, defined as death, transplant, BDG/Fontan takedown, or revision was 81% at 5 years. At a mean follow-up of 39.8 months, 90 patients (75%) were in New York Heart Association class I. Patients with failing cavopulmonary circulation had higher pre-BDG pulmonary artery pressure (PAP) (18.3+/-6.1 mm Hg versus 14.8+/-5.1 mm Hg, P=0.016) and higher pre-BDG transpulmonary gradient (TPG) (11.2+/-6.2 mm Hg versus 7.7+/-4.3 mm Hg, P=0.014). Post-BDG, patients with palliation failure had increased PAP (15.0+/-5.7 mm Hg versus 10.8+/-2.8 mm Hg, P=0.008) and indexed pulmonary vascular resistance (PVRI) (2.43+/-1.0 Wood U . m(2) versus 1.52+/-0.9 Wood U . m(2), P=0.007). CONCLUSIONS: The majority of patients at moderate altitude have favorable outcomes after BDG or Fontan palliation. Risk factors for palliation failure at elevated altitude include PAP >15 mm Hg, TPG >8 mm Hg, and PVRI >2.5 Wood U . m(2).
Authors: Mark A Scheurer; Elizabeth G Hill; Nagavardhan Vasuki; Scott Maurer; Eric M Graham; Varsha Bandisode; Girish S Shirali; Andrew M Atz; Scott M Bradley Journal: J Thorac Cardiovasc Surg Date: 2007-07 Impact factor: 5.209
Authors: T L Gentles; J E Mayer; K Gauvreau; J W Newburger; J E Lock; J P Kupferschmid; J Burnett; R A Jonas; A R Castañeda; G Wernovsky Journal: J Thorac Cardiovasc Surg Date: 1997-09 Impact factor: 5.209
Authors: Ed Petrossian; V Mohan Reddy; Kathryn K Collins; Casey B Culbertson; Malcolm J MacDonald; John J Lamberti; Olaf Reinhartz; Richard D Mainwaring; Paul D Francis; Sunil P Malhotra; David B Gremmels; Sam Suleman; Frank L Hanley Journal: J Thorac Cardiovasc Surg Date: 2006-11 Impact factor: 5.209
Authors: Riad B M Hosein; Andrew J B Clarke; Simon P McGuirk; Massimo Griselli; Oliver Stumper; Joseph V De Giovanni; David J Barron; William J Brawn Journal: Eur J Cardiothorac Surg Date: 2007-01-22 Impact factor: 4.191
Authors: Max B Mitchell; David N Campbell; Dunbar Ivy; Mark M Boucek; Henry M Sondheimer; Biagio Pietra; Bibhuti B Das; Joseph R Coll Journal: J Thorac Cardiovasc Surg Date: 2004-11 Impact factor: 5.209
Authors: C J Knott-Craig; G K Danielson; H V Schaff; F J Puga; A L Weaver; D D Driscoll Journal: J Thorac Cardiovasc Surg Date: 1995-06 Impact factor: 5.209
Authors: Jeffrey A Feinstein; D Woodrow Benson; Anne M Dubin; Meryl S Cohen; Dawn M Maxey; William T Mahle; Elfriede Pahl; Juan Villafañe; Ami B Bhatt; Lynn F Peng; Beth Ann Johnson; Alison L Marsden; Curt J Daniels; Nancy A Rudd; Christopher A Caldarone; Kathleen A Mussatto; David L Morales; D Dunbar Ivy; J William Gaynor; James S Tweddell; Barbara J Deal; Anke K Furck; Geoffrey L Rosenthal; Richard G Ohye; Nancy S Ghanayem; John P Cheatham; Wayne Tworetzky; Gerard R Martin Journal: J Am Coll Cardiol Date: 2012-01-03 Impact factor: 24.094
Authors: Steven M Schwartz; Minmin Lu; Richard G Ohye; Kevin D Hill; Andrew M Atz; Maryam Y Naim; Ismee A Williams; Caren S Goldberg; Alan Lewis; Frank Pigula; Peter Manning; Christian Pizarro; Paul Chai; Rachel McCandless; Carolyn Dunbar-Masterson; Jonathan R Kaltman; Kirk Kanter; Lynn A Sleeper; Julie V Schonbeck; Nancy Ghanayem Journal: J Thorac Cardiovasc Surg Date: 2013-09-24 Impact factor: 5.209
Authors: Zhi Zhou; Sunil P Malhotra; Xiaoyang Yu; Jennifer Rutledge; Ivan M Rebeyka; David B Ross; Christopher Rausch; Hong Gu; Brian McCrindle; Francois Lacour-Gayet; Dunbar Ivy; Jia Li Journal: J Thorac Cardiovasc Surg Date: 2013-01-23 Impact factor: 5.209
Authors: Benjamin S Frank; Ludmila Khailova; Lori Silveira; Max B Mitchell; Gareth J Morgan; Michael V DiMaria; Jesse A Davidson Journal: J Am Heart Assoc Date: 2022-03-04 Impact factor: 6.106
Authors: Benjamin S Frank; Ludmila Khailova; Lori Silveira; Max B Mitchell; Gareth J Morgan; Elena W Y Hsieh; Michael V DiMaria; Mark Twite; Jelena Klawitter; Jesse A Davidson Journal: Transl Res Date: 2020-10-09 Impact factor: 7.012