Chen Qiang, Tulloh Robert, Caputo Massimo, Stoica Serban, Kia Matina, Parry Andrew J
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK.
Department of Cardiology, Bristol Royal Hospital for Children, Bristol, UK.
Eur J Cardiothorac Surg. 2015 Jan;47(1):154-8; discussion 158. doi: 10.1093/ejcts/ezu170. Epub 2014 Apr 30.
To evaluate outcomes of the Glenn procedure with or without pulsatile antegrade pulmonary blood flow during palliation of patients with functionally single ventricles.
The clinical records of 111 consecutive patients who underwent a bidirectional Glenn procedure for palliation of single ventricle morphologies at our institution between 1997 and 2010 were reviewed. We specifically excluded infants with the diagnosis of hypoplastic left heart syndrome. Following the Glenn procedure, there were 57 patients (Group 1) with and 54 (Group 2) without antegrade pulmonary blood flow. We reviewed their long term data from our database to determine whether the presence of forward flow after the Glenn procedure affected outcome.
There was 1 early hospital death (in Group 1). The mean SaO2 at discharge was higher in Group 1 (83%±2 vs 78%±4; P<0.001). There was no difference in duration of chest drain insertion, length of intensive care and hospital stay between the two groups. The median follow-up time was 7.1 years (range, 1.7-14.9 years). Sixty-five patients underwent Fontan completion (35 from Group 1) a median of 3.6 years (Group 1) and 3.3 (Group 2) after the Glenn procedure. Three patients died following Fontan completion (1 from Group 1). The 5- and 10-year survival (95% CI) was 96% (84-98%) and 96% (84-98%) in Group 1, and 88% (74-94%) and 82% (66-91%) in Group 2, respectively (log-rank; P=0.03). There was no significant difference in SaO2 levels, or incidence of systemic atrioventricular valve regurgitation or ventricular dysfunction in survivors between groups at the last follow-up.
We conclude that leaving antegrade flow following a Glenn procedure improves oxygen saturation significantly and while it does not impact on short term outcome or hospital stay, long-term outcome is significantly better.
评估功能性单心室患者姑息治疗期间采用或不采用搏动性顺行肺血流的格林手术的效果。
回顾了1997年至2010年间在本机构接受双向格林手术以姑息治疗单心室形态的111例连续患者的临床记录。我们特别排除了诊断为左心发育不全综合征的婴儿。格林手术后，57例患者（第1组）有顺行肺血流，54例（第2组）没有顺行肺血流。我们从数据库中回顾了他们的长期数据，以确定格林手术后顺行血流的存在是否影响预后。
有1例早期医院死亡（在第1组）。第1组出院时的平均动脉血氧饱和度较高（83%±2对78%±4；P<0.001）。两组之间胸腔引流管插入时间、重症监护时间和住院时间没有差异。中位随访时间为7.1年（范围1.7 - 14.9年）。65例患者接受了Fontan手术完成（第1组35例），格林手术后中位时间为3.6年（第1组）和3.3年（第2组）。3例患者在Fontan手术完成后死亡（第1组1例）。第1组5年和10年生存率（95%CI）分别为96%（84 - 98%）和96%（84 - 98%），第2组分别为88%（74 - 94%）和82%（66 - 91%）（对数秩检验；P = 0.03）。在最后一次随访时，两组幸存者的动脉血氧饱和度水平、体循环房室瓣反流发生率或心室功能障碍发生率没有显著差异。
我们得出结论，格林手术后保留顺行血流可显著提高氧饱和度，虽然它不影响短期预后或住院时间，但长期预后明显更好。
