Abstract
BackgroundSecond-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures.Material and methodsWe analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications.ResultsThe patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures.ConclusionSignificant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures.
Highlights
Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease
Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/ sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation
Second-stage palliation of single-ventricle heart performed with the hemi-Fontan method consists of anastomosing the superior vena cava (SVC) with the pulmonary arteries close to the SVC insertion to the right atrium, while the SVC insertion is separated from the right atrial cavity by means of a transverse patch sutured to the right atrial walls
Summary
Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. Second-stage palliation of single-ventricle heart performed with the hemi-Fontan method consists of anastomosing the superior vena cava (SVC) with the pulmonary arteries close to the SVC insertion to the right atrium, while the SVC insertion is separated from the right atrial cavity by means of a transverse patch sutured to the right atrial walls. Such a location of the incision line, anastomosis and patch suturing lines, and future scar formation in this region, pose a risk of damaging the sinus node and/or impulse conduction pathways from the sinus node. Hemi-Fontan does not allow for a selection of the Fontan operation technique to match the anatomy of a defect [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
