Talwar Sachin, Sandup Tsering, Gupta Saurabh, Ramakrishnan Sivasubramanian, Kothari Shyam Sunder, Saxena Anita, Juneja Rajnish, Choudhary Shiv Kumar, Airan Balram
Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, 10029 India.
Indian J Thorac Cardiovasc Surg. 2018 Oct;34(4):457-467. doi: 10.1007/s12055-017-0571-5. Epub 2017 Aug 22.
The bidirectional Glenn (BDG) procedure is a step in multistage palliation of univentricular heart (UVH). We aimed to report the factors determining the outcomes following BDG.
Two hundred fifteen consecutive patients, 5.29 ± 5 years (range 1 month to 38 years, median 3 years) of age, weighing 13 ± 8.8 kg (range 2.6 to 51 kg, median 10 kg) with variable forms of UVH underwent BDG from 2003 to 2013. Their clinical records were reviewed retrospectively.
The most common anatomic diagnoses were tricuspid atresia ( = 87, 40.5%) and double outlet right ventricle ( = 78, 36%). Dextrocardia was present in 21 (9.86%) patients. Median left pulmonary (PA) and right PA diameters were 6 and 7 mm, respectively. One hundred sixty-two (77%) patients received unilateral BDG, and 45 had bilateral BDG. The antegrade pulmonary blood flow was closed in 199 and was left open in 16 patients. Concomitant procedures were reconstruction of pulmonary arteries for non-confluent PA ( = 28), atrial septectomy ( = 15), atrioventricular valve repair ( = 12) and repair of partial anomalous pulmonary venous connection ( = 1). A total of 37% of patients ( = 80) had a mean post-operative saturation of 90 ± 3.2%. There were four (1.86%) early deaths. Mean Glenn pressure was 14.7 ± 3.5 mm Hg, and mean inotropic score and Vasoactive inotropic score (VIS) were 1.64 ± 0.96 and 2.77 ± 2.63, respectively. Mean intensive care unit stay was 24.1 ± 26.4 (range 10-240) h, and mean duration of hospital stay was 7.15 ± 3.2 days. Mean saturation at the time of discharge was 92.4 ± 2.2% and on follow-up was 82 ± 2.16%. Follow-up cardiac catheterization data was available in 123 (60.3%). Sixty-nine (33.8%) patients underwent completion Fontan, and 135 patients were in follow-up or waiting for Fontan completion.
BDG procedure can be performed safely with acceptable mortality. Age at presentation, pulmonary artery size and VIS were not related to mortality. Younger patients had similar outcomes but a longer hospital stay. Patients with preserved antegrade pulmonary blood flow had higher saturations. Those undergoing BDG without cardiopulmonary bypass had lower inotropic scores.
双向格林（BDG）手术是单心室心脏（UVH）多阶段姑息治疗中的一个步骤。我们旨在报告决定BDG术后结局的因素。
2003年至2013年，连续215例年龄为5.29±5岁（范围1个月至38岁，中位数3岁）、体重13±8.8 kg（范围2.6至51 kg，中位数10 kg）的不同类型UVH患者接受了BDG手术。对他们的临床记录进行回顾性分析。
最常见的解剖诊断是三尖瓣闭锁（n = 87，40.5%）和右心室双出口（n = 78，36%）。21例（9.86%）患者存在右位心。左肺动脉（PA）和右PA的中位数直径分别为6和7 mm。162例（77%）患者接受了单侧BDG，45例接受了双侧BDG。199例患者的顺行性肺血流被阻断，16例患者的肺血流保持开放。同期手术包括对不融合的PA进行肺动脉重建（n = 28）、房间隔切除术（n = 15）、房室瓣修复（n = 12）和部分肺静脉异位连接修复（n = 1）。共有37%的患者（n = 80）术后平均饱和度为90±3.2%。有4例（1.86%）早期死亡。平均格林压为14.7±3.5 mmHg，平均正性肌力评分和血管活性正性肌力评分（VIS）分别为1.64±0.96和2.77±2.63。平均重症监护病房停留时间为24.1±26.4（范围10 - 240）小时，平均住院时间为7.15±3.2天。出院时的平均饱和度为92.4±2.2%，随访时为82±2.16%。123例（60.3%）患者有随访心脏导管检查数据。69例（33.8%）患者接受了全腔静脉-肺动脉连接术（Fontan），135例患者正在随访或等待完成Fontan手术。
BDG手术可以安全进行，死亡率可接受。就诊时年龄、肺动脉大小和VIS与死亡率无关。年轻患者结局相似，但住院时间较长。保留顺行性肺血流的患者饱和度较高。未进行体外循环接受BDG手术的患者正性肌力评分较低。
