Kogon Brian E, Plattner Courtney, Leong Traci, Simsic Janet, Kirshbom Paul M, Kanter Kirk R
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
J Thorac Cardiovasc Surg. 2008 Nov;136(5):1237-42. doi: 10.1016/j.jtcvs.2008.05.017. Epub 2008 Jul 17.
Patients with single ventricle heart defects often undergo a palliative bidirectional Glenn operation. For this operation, we analyzed potential risk factors for morbidity and mortality. We also evaluated the effects of a persistent left superior vena cava by comparing the outcomes of unilateral and bilateral operations.
We reviewed the clinical records of 270 consecutive patients who underwent a bidirectional Glenn operation between 2001 and 2007. A total of 226 patients underwent unilateral operations and 44 patients underwent bilateral operations. Patient characteristics included weight and age, single ventricle morphology, vena caval anatomy, and previous surgery. Operative details included cardiopulmonary bypass technique and duration, pulmonary artery management, hemi-Fontan construction, concomitant procedures, and hemodynamics. Outcome data included duration of chest tube drainage, lengths of intensive care unit and hospital stay, morbidity, and mortality (<30 days).
The median length of chest tube drainage was 2.4 days (range 1-20 days). Risk factors for prolonged drainage were elevated central venous pressure (P = .015) and transpulmonary gradient (P = .011). The median lengths of stay in the intensive care unit and hospital were 50 hours (range 20-1628 hours) and 5 days (range 2-83 days), respectively. Risk factors for both included prolonged cardiopulmonary bypass time, elevated central venous pressure and transpulmonary gradient, and right ventricular morphology. Overall, 72 of 270 patients (27%) had 116 postoperative complications. Risk factors included prolonged cardiopulmonary bypass time (P = .002) and elevated central venous pressure (P = .029). Mortality was 2 of 270 patients (0.7%). No risk factors for death were identified. Weight (median 6.8 kg vs 6.2 kg, P = .038) and age (median 186 days vs 159 days, P = .001) at the time of surgery were significantly greater in the bilateral bidirectional Glenn group compared with the unilateral group. However, there was no difference in any of the outcome variables.
Outcomes were adversely affected primarily by prolonged cardiopulmonary bypass time, elevated central venous pressure and transpulmonary gradient, and right ventricular morphology. Specifically, outcomes were unaffected by the presence of a left superior vena cava, cannulation strategy, or antegrade pulmonary blood flow. There were few differences between the unilateral and bilateral groups, none of which were postoperative outcomes.
单心室心脏缺陷患者常需接受姑息性双向格林手术。针对该手术，我们分析了发病和死亡的潜在危险因素。我们还通过比较单侧和双侧手术的结果，评估了永存左上腔静脉的影响。
我们回顾了2001年至2007年间连续270例行双向格林手术患者的临床记录。其中226例患者接受单侧手术，44例患者接受双侧手术。患者特征包括体重和年龄、单心室形态、腔静脉解剖结构以及既往手术史。手术细节包括体外循环技术及持续时间、肺动脉处理、半Fontan构建、同期手术及血流动力学情况。结果数据包括胸管引流持续时间、重症监护病房和住院时间、发病率及死亡率（<30天）。
胸管引流的中位持续时间为2.4天（范围1 - 20天）。引流时间延长的危险因素为中心静脉压升高（P = 0.015）和跨肺压梯度升高（P = 0.011）。重症监护病房和住院的中位时间分别为50小时（范围20 - 1628小时）和5天（范围2 - 83天）。两者的危险因素均包括体外循环时间延长、中心静脉压和跨肺压梯度升高以及右心室形态。总体而言，270例患者中有72例（27%）出现116例术后并发症。危险因素包括体外循环时间延长（P = 0.002）和中心静脉压升高（P = 0.029）。死亡率为270例患者中的2例（0.7%）。未发现死亡的危险因素。与单侧组相比，双侧双向格林组手术时的体重（中位值6.8 kg对6.2 kg，P = 0.038）和年龄（中位值186天对159天，P = 0.001）显著更高。然而，在任何结局变量方面均无差异。
主要受体外循环时间延长、中心静脉压和跨肺压梯度升高以及右心室形态的不利影响。具体而言，结局不受左上腔静脉的存在、插管策略或顺行性肺血流的影响。单侧组和双侧组之间差异很少，且均不是术后结局方面的差异。
