Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Division of Congenital and Pediatric Heart Surgery, Ludwig-Maximilians-Universität, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
Eur J Cardiothorac Surg. 2021 Jul 30;60(2):369-376. doi: 10.1093/ejcts/ezab079.
The present study was aiming to determine whether high mean pulmonary artery pressure before bidirectional cavopulmonary shunt is a risk factor for late adverse events in patients with low pulmonary artery pressure before total cavopulmonary connection (TCPC).
We retrospectively reviewed the medical records of all patients undergoing both bidirectional cavopulmonary shunt and TCPC with available cardiac catheterization data.
A total of 316 patients were included in this study. The patients were divided into 4 groups according to mean pulmonary pressure: those with pre-Glenn <16 mmHg and pre-Fontan <10 mmHg (Group LL, n = 124), those with pre-Glenn ≥16 mmHg and pre-Fontan <10 mmHg (Group HL, n = 61), those with pre-Glenn <16 mmHg and pre-Fontan ≥10 mmHg (Group LH, n = 66) and those with pre-Glenn ≥16 mmHg and pre-Fontan ≥10 mmHg (Group HH, n = 65). Group HL showed significantly higher rate of adverse events after TCPC than Group LL (P = 0.02). In univariate linear analysis, a history of atrial septectomy at stage 1 palliation was associated with low pre-Glenn mean pulmonary artery pressure (Coefficient B -1.38, 95% confidence interval -2.53 to -0.24; P = 0.02), while pulmonary artery banding was a significant risk factor for elevated pre-Fontan mean pulmonary artery pressure (Coefficient B 1.68, 95% confidence interval 0.81 to 2.56, P < 0.001).
High mean pulmonary artery pressure before bidirectional cavopulmoary shunt (≥16mmHg) remains a significant risk factor for adverse events after TCPC even though mean pulmonary artery pressure decreased below 10 mmHg before TCPC.
本研究旨在确定双向格林术前行肺动脉平均压（mPAP）增高是否是总腔静脉肺动脉吻合前行 mPAP 较低患者（TCPC）晚期不良事件的危险因素。
我们回顾性分析了所有接受双向格林术和 TCPC 治疗且有心脏导管检查数据的患者的病历。
本研究共纳入 316 例患者。根据 mPAP 将患者分为 4 组：Glenn 术前＜16mmHg 且 Fontan 术前＜10mmHg（LL 组，n=124）、Glenn 术前≥16mmHg 且 Fontan 术前＜10mmHg（HL 组，n=61）、Glenn 术前＜16mmHg 且 Fontan 术前≥10mmHg（LH 组，n=66）、Glenn 术前≥16mmHg 且 Fontan 术前≥10mmHg（HH 组，n=65）。HL 组 TCPC 后不良事件发生率明显高于 LL 组（P=0.02）。单因素线性分析显示，一期姑息性治疗行房间隔切开术与 Glenn 术前 mPAP 降低相关（B 系数-1.38，95%置信区间-2.53 至-0.24；P=0.02），而肺动脉带缩术是 Fontan 术前 mPAP 升高的显著危险因素（B 系数 1.68，95%置信区间 0.81 至 2.56，P＜0.001）。
即使 TCPC 前行 mPAP 降至 10mmHg 以下，双向格林术前行 mPAP （≥16mmHg）增高仍然是 TCPC 后不良事件的显著危险因素。
