Tao Zhang1, Yisheng Shi2, Kaihong Wu3, Zhongdong Hua4, Shoujun Li4, Shengshou Hu4, Hao Zhang5. 1. Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China; Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shandong, China. 2. Department of Echocardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China. 3. Department Cardiac Surgery, Nanjing Children Hospital, Nanjing, China. 4. Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China. 5. Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China. Electronic address: drzhanghao@yahoo.com.
Abstract
BACKGROUND: Given the low rate of Fontan completion, an aggressive policy for maintaining antegrade pulmonary blood flow (AnPBF) during the bidirectional Glenn procedure (BDG) was developed for the functional single ventricle. METHODS: From 2008 to 2013, 294 patients who underwent the BDG were divided into two groups: group 1 (uncontrolled AnPBF, n = 270) and group 2 (controlled AnPBF, n = 24). Pulmonary artery banding was performed because of the high central venous pressure in group 2. In group 1, the patients who underwent BDG from 2008 to 2012 were further divided into group DF (delayed Fontan completion, n = 109) and group FC (Fontan completion, n = 42). RESULTS: The Fontan completion rate was 16.3%, and the average interval time was 2.2 ± 1.1 years. The delay of Fontan completion did not reduce body weight gain or the survival rate. Furthermore, oxygen saturation was slightly reduced in group DF. Although no impairments of heart function were observed, the uncontrolled AnPBF in group DF resulted in an increase in ventricular end-diastolic diameter and aggravation of atrioventricular valve regurgitation over 24 months after BDG. Logistic regression analysis revealed that systemic right ventricular morphology was a risk factor for the aggravation of valve regurgitation. CONCLUSIONS: The low Fontan achievement rate is a critical issue in China. Although the patients with delayed Fontan completion exhibited an acceptable survival rate and acceptable body weight gain, uncontrolled AnPBF was associated with ventricular enlargement and aggravation of valve regurgitation. Strategies for improving the Fontan completion rate in China should be explored and could benefit outcomes.
BACKGROUND: Given the low rate of Fontan completion, an aggressive policy for maintaining antegrade pulmonary blood flow (AnPBF) during the bidirectional Glenn procedure (BDG) was developed for the functional single ventricle. METHODS: From 2008 to 2013, 294 patients who underwent the BDG were divided into two groups: group 1 (uncontrolled AnPBF, n = 270) and group 2 (controlled AnPBF, n = 24). Pulmonary artery banding was performed because of the high central venous pressure in group 2. In group 1, the patients who underwent BDG from 2008 to 2012 were further divided into group DF (delayed Fontan completion, n = 109) and group FC (Fontan completion, n = 42). RESULTS: The Fontan completion rate was 16.3%, and the average interval time was 2.2 ± 1.1 years. The delay of Fontan completion did not reduce body weight gain or the survival rate. Furthermore, oxygen saturation was slightly reduced in group DF. Although no impairments of heart function were observed, the uncontrolled AnPBF in group DF resulted in an increase in ventricular end-diastolic diameter and aggravation of atrioventricular valve regurgitation over 24 months after BDG. Logistic regression analysis revealed that systemic right ventricular morphology was a risk factor for the aggravation of valve regurgitation. CONCLUSIONS: The low Fontan achievement rate is a critical issue in China. Although the patients with delayed Fontan completion exhibited an acceptable survival rate and acceptable body weight gain, uncontrolled AnPBF was associated with ventricular enlargement and aggravation of valve regurgitation. Strategies for improving the Fontan completion rate in China should be explored and could benefit outcomes.
Authors: K Kalia; P Walker-Smith; M V Ordoñez; F G Barlatay; Q Chen; H Weaver; M Caputo; S Stoica; A Parry; R M R Tulloh Journal: Pediatr Cardiol Date: 2021-04-19 Impact factor: 1.655