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A Comparison of Bidirectional Glenn vs. Hemi-Fontan Procedure: An Analysis of the Single Ventricle Reconstruction Trial Public Use Dataset.
Pediatric Cardiology ( IF 1.5 ) Pub Date : 2020-05-29 , DOI: 10.1007/s00246-020-02371-6
Jonathan B Edelson 1 , Chitra Ravishankar 1 , Heather Griffis 2 , Xuemei Zhang 2 , Jennifer Faerber 2 , Monique M Gardner 1, 3 , Maryam Y Naim 1, 3 , Christopher E Macsio 4 , Andrew C Glatz 1, 5 , David J Goldberg 1
Affiliation  

Patients with single ventricle (SV) heart defects have two primary surgical options for superior cavopulmonary connection (SCPC): bidirectional Glenn (BDG) and hemi-Fontan (HF). Outcomes based on type of SCPC have not been assessed in a multi-center cohort. This retrospective cohort study uses the Single Ventricle Reconstruction (SVR) Trial public use dataset. Infants who survived to SCPC were evaluated through 1 year of age, based on type of SCPC. The primary outcome was transplant-free survival at 1 year. The cohort included 343 patients undergoing SCPC across 15 centers in North America; 250 (73%) underwent the BDG. There was no difference between the groups in pre-SCPC clinical characteristics. Cardiopulmonary bypass times were longer [99 min (IQR 76, 126) vs 81 min (IQR 59, 116), p < 0.001] and use of deep hypothermic circulatory arrest (DHCA) more prevalent (51% vs 19%, p < 0.001) with HF. Patients who underwent HF had a higher likelihood of experiencing more than one post-operative complication (54% vs 41%, p = 0.05). There were no other differences including the rate of post-operative interventional cardiac catheterizations, length of stay, or survival at discharge, and there was no difference in transplant-free survival out to 1 year of age. Mortality after SCPC is low and there is no difference in mortality at 1 year of age based on type of SCPC. Differences in support time and post-operative complications support the preferential use of the BDG, but additional longitudinal follow-up is necessary to understand whether these differences have implications for long-term outcomes.



中文翻译:

双向Glenn与Hemi-Fontan程序的比较:单心室重建试验公共用途数据集的分析。

单心室(SV)心脏缺损的患者可通过两种主要的手术选择上腔静脉连接(SCPC):双向Glenn(BDG)和半氟坦(HF)。尚未在多中心队列中评估基于SCPC类型的结果。这项回顾性队列研究使用单心室重构(SVR)试验公共用途数据集。根据SCPC的类型,对存活至SCPC的婴儿进行评估,直至1岁。主要结果是1年无移植生存。该队列包括北美15个中心的343名接受SCPC的患者。250名(73%)参加了BDG。两组之间SCPC前的临床特征无差异。心肺旁路时间更长[99分钟(IQR 76,126)与81分钟(IQR 59,116),p <0.001]和使用 HF的深部低温循环性停搏(DHCA)更为普遍(51%比19%,p <0.001)。进行心力衰竭的患者术后发生一种以上并发症的可能性更高(54%vs 41%,p = 0.05)。没有其他差异,包括术后介入性心脏导管插入术的发生率,住院时间或出院时的生存率,至1岁时的无移植生存率也没有差异。SCPC后的死亡率很低,并且根据SCPC的类型,1岁以下的死亡率没有差异。支持时间和术后并发症的差异支持了BDG的优先使用,但是有必要进行额外的纵向随访,以了解这些差异是否对长期结果产生影响。

更新日期:2020-05-29
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