Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Eur J Cardiothorac Surg. 2021 Sep 11;60(3):534-541. doi: 10.1093/ejcts/ezab126.
The Super Glenn procedure involves targeted increased in blood flow to left sided heart structures with fenestrated atrial septation. The objective of this study was to examine the outcomes of patients who had this procedure as a part of biventricular staging and specifically evaluate the effect on dimensions of left heart structures.
Data for patients who had this procedure between 2005 and 2019 were retrospectively identified.
Thirty-seven patients were identified. Most common diagnosis was hypoplastic left heart syndrome in 40% (n = 15). On echocardiography, the median mitral valve z score was -2.26. On cardiac magnetic resonance imaging, median indexed left ventricular end-diastolic volume was 31.5 ml/m2 and mitral/tricuspid inflow ratio was 0.35. The median age at Super Glenn was 2.3 years (interquartile range 1.5-3.6) while median weight was 12 kg (interquartile range 9.8-14). There were no early/hospital deaths. The median intensive care unit length of stay was 4 days, and median hospital length of stay was 10 days. Median follow-up for the entire cohort was 3 years (range 15 days to 13.2 years). There was a statistically significant increase in indexed left ventricular dimensions. There were 5 deaths (14%). Three patients (8%) underwent heart transplant. Freedom from death/transplant was 79% at 5 years. Seven patients (19%) needed a reoperation. Twenty-three patients (62%) underwent biventricular conversion after a median of 11.3 months after Super Glenn.
The Super Glenn procedure achieves consistent increase in left ventricular dimensions. This may be a useful strategy to help achieve a successful biventricular circulation in patients with borderline left ventricle. The superiority/non-inferiority of this approach over the conventional Fontan pathway is unclear.
Super Glenn 手术通过房间隔开窗使左心结构的血流靶向增加。本研究的目的是检查作为双心室分期一部分接受该手术的患者的结局，并特别评估其对左心结构尺寸的影响。
回顾性地确定了 2005 年至 2019 年期间接受该手术的患者的数据。
共确定了 37 例患者。最常见的诊断是左心发育不全综合征，占 40%（n=15）。在超声心动图上，二尖瓣 z 评分中位数为-2.26。在心脏磁共振成像上，左心室舒张末期容积指数中位数为 31.5ml/m2，二尖瓣/三尖瓣流入比为 0.35。Super Glenn 手术的中位年龄为 2.3 岁（四分位距 1.5-3.6），中位体重为 12kg（四分位距 9.8-14）。无早期/院内死亡。中位重症监护病房住院时间为 4 天，中位住院时间为 10 天。整个队列的中位随访时间为 3 年（范围为 15 天至 13.2 年）。左心室指数有显著增加。有 5 例死亡（14%）。3 例患者（8%）接受了心脏移植。5 年时无死亡/移植生存率为 79%。7 例患者（19%）需要再次手术。Super Glenn 后中位时间 11.3 个月后，23 例患者（62%）接受了双心室转换。
Super Glenn 手术可使左心室尺寸持续增加。对于左心室边缘患者，这可能是实现双心室循环成功的有用策略。该方法优于传统 Fontan 途径的优越性/非劣效性尚不清楚。
