Outcomes after Bidirectional Glenn Operation in Single Ventricular Anatomy: A Single Centre Experience

Abstract

Outcomes after Bidirectional Glenn Operation in Single Ventricular Anatomy: A Single Centre Experience Maqsood M. Elahi 1,∗, Hong C. Chew1, Hari Ravindranathan2, Alan Farnsworth1, Graham R. Nunn1, David Winlaw1, Peter W. Grant 1 1Department of Cardiothoracic Surgery, Sydney Children’s Hospital, Barker Street, Randwick, NSW, Australia 2 Department of Neonatal & Children’s Intensive Care, Sydney Children’s Hospital, Barker Street, Randwick, NSW, Australia Objective: The bidirectional Glenn (BDG) procedure is a well-established procedure. Numerous studies have highlighted its potential benefits in the single-ventricle palliation pathway. We report our experience for predictive variables and outcomes associated with BDG procedures. Methods: Demographics, age at the time of the BDG procedure, associated procedures, length of hospital stay, duration ofmechanical ventilation, length of ICU stay, and primary diagnoses for 29 consecutive patients undergoing the BDG procedure was collected. All data were analysed with Kaplan–Meier survival analysis and the Cox proportional hazard regression test to assess the probability of survival after the BDG procedure. A stepwise regression analysis was performed for identification of independent factors for postoperative oxygen saturation at hospital discharge. and demonstrate that performing BDG procedure at sixmonths of age is feasible and safe. doi:10.1016/j.hlc.2010.11.057 Surgery vs Percutaneous Valvuloplasty for Neonatal and Infant Critical Aortic Stenosis Fountas Nikolas ∗, Cole Andrew, Roberts Philip, Chard Richard ∗ Optimal management for critical aortic stenosis in neonatal and infantpopulations ispoorlyunderstood.This study sought to evaluate outcomes of percutaneous transcatheter balloon valvuloplasty versus surgical therapy. Thirty-nine neonates and 37 infants (mean age 10 days and 4.3 months respectively) underwent treatment for critical aortic stenosis at the Children’s Hospital Westmead between 1998 and 2010. Valvuloplasty was done in 37 (95%) neonates and 37 (100%) infants. Aortic valvotomy, Konno, or Ross-Konno procedures were performed in 12 (31%) neonates and seven (19%) infants. Ten patients had surgery for concomitant aortic coarctation repair (nine), mitral valvotomy/repair (two), or ASD closure (one). Four neonate mortalities occurred (10%); all balloon valvuloplasty related.Re-interventions, either catheteror surgery, occurred in 15 (38%) neonates andnine (24%) infants. Four patients (three neonate, one infant) required both catheter Results: All patients in our study except two required initial palliation with either BT shunt or PA banding in early postnatal care. The mean period from initial surgery to BDG surgerywas approximately 11months. At the time of the BDG procedure, the youngest patient was fivemonths old, and the oldest patient was 4.5 years old. There was an equal distribution of patients with right-sided or leftsided single ventricle anatomy. The postoperative oxygen saturations at discharge (all on room air) were positively associated with previous antegrade flow defined as any flow through the native pulmonary artery and pulmonary valve (P< 0.005) and negatively associated with preoperative end-diastolic ventricular pressure (P< 0.005). Age at the time of the BDG procedure was not associated with worse postoperative oxygen saturations at discharge. There was only one late death (3.4%). Time to Fontan procedure was 23± 4.5 months. The significant independent variables for morbidity in Fontan completion after the BDG procedure were preoperative mean pulmonary artery pressure, bypass time and postoperative oxygen saturations. Conclusion: Our results demonstrated that low mortality in single ventricle anatomy. We found that the post-BDG oxygen saturations at hospital discharge were associated with previous native antegrade flow. We hypothesise that antegrade native pulmonary flow include promotion of normal pulmonary artery growth andmaintenance of pulmonary artery endothelial function for a better outcome towards Fontan completion. Our results support the international trend towards BDG procedure in younger age and surgical re-interventions. Children requiring intervention for congenital critical aortic stenosis as neonates fared worse than infants in mortality and re-intervention rates, and surgery was safe and effective when catheter intervention was unsuccessful. doi:10.1016/j.hlc.2010.11.058 Effect of Physical Activity on Continuous-Flow Left Ventricular Assist Device Function in Outpatients Sharon Hu1,2,3,∗, Anne Keogh1,2, Peter Macdonald1,2, Eugene Kotlyar 1, Desiree Robson1, Michelle Harkess 1, Paul Jansz1,3, Phillip Spratt 1,3, Chris Hayward1,2 1Heart Failure and Transplant Unit, St Vincent’s Hospital, Sydney, Australia 2 Faculty of Medicine, The University of New South Wales, Sydney, Australia 3 Department of Cardiothoracic Surgery, St Vincent’s Hospital, Sydney, Australia Introduction: Left ventricular assist devices (LVADs) augment the heart’s pumping action in patientswithmedically refractory heart failure. Pump flow in continuousflow LVADs have been shown to increase with graded exercise testing [1,2]. However, data on pump behaviour during activities of daily living where cardiac output requirements vary are lacking. Purpose: To observe whether LVAD flow changes with everyday physical activity without active alterations in pump settings.