Discipline of Cardiac Surgery, State University of Campinas, UNICAMP, Campinas, Brazil.
J Thorac Cardiovasc Surg. 2010 Mar;139(3):562-8. doi: 10.1016/j.jtcvs.2009.08.025. Epub 2009 Nov 11.
The bidirectional Glenn procedure is a well-established procedure performed as part of the single-ventricle palliation pathway. Numerous studies have highlighted the potential benefits of an "early" BDG procedure. The ideal age to perform the BDG procedure, however, remains uncertain. We report our experience with the BDG procedure in patients younger than 3 months.
One hundred sixty-nine consecutive patients from 1998 to 2007 undergoing the BDG procedure were divided into 2 groups: younger than 3 months (n = 20) and older than 3 months. The groups were compared for 26 variables. All data were analyzed with Kaplan-Meier survival analysis and the Cox proportional hazard regression test to assess the probability of survival after the BDG procedure in both groups. A stepwise regression analysis was performed for identification of independent factors for postoperative oxygen saturation at hospital discharge.
The groups were comparable, with an equal distribution of patients with right-sided or left-sided single-ventricle anatomy. Although intensive care unit length of stay, ventilation time, and hospital length of stay were longer in the younger group, room air oxygen saturations at discharge, both early and late mortality, and time to the Fontan procedure were similar between groups. The independent variables found for death after the BDG procedure were preoperative mean pulmonary artery pressure, atrioventricular valve regurgitation, and postoperative oxygen saturations at hospital discharge. Survival in patients with hypoplastic left heart syndrome was comparable between groups after 5 years of follow-up.
The BDG procedure is feasible and safe in patients as young as 2 months of age, with early and late mortality equivalent to that seen in older patients.
双向 Glenn 手术是作为单心室姑息治疗途径的一部分而进行的一项成熟手术。许多研究强调了“早期”BDG 手术的潜在益处。然而，进行 BDG 手术的理想年龄仍不确定。我们报告了我们在 3 个月以下的患者中进行 BDG 手术的经验。
1998 年至 2007 年期间，169 例连续接受 BDG 手术的患者被分为两组：<3 个月（n=20）和>3 个月。比较两组 26 个变量。所有数据均采用 Kaplan-Meier 生存分析和 Cox 比例风险回归检验进行分析，以评估两组患者 BDG 手术后的生存率。进行逐步回归分析，以确定术后住院期间血氧饱和度的独立因素。
两组患者在右或左单心室解剖结构的患者分布均等，具有可比性。尽管年轻组的重症监护病房住院时间、通气时间和住院时间较长，但出院时的空气氧饱和度、早期和晚期死亡率以及 Fontan 手术时间在两组之间相似。BDG 手术后死亡的独立变量为术前平均肺动脉压、房室瓣反流和术后住院期间的血氧饱和度。5 年随访后，左心发育不全综合征患者的生存率在两组之间相当。
BDG 手术在 2 个月大的患者中是可行且安全的，其早期和晚期死亡率与年龄较大的患者相当。
