Abstract 13961: Risk Factors for Adverse Outcomes After a Glenn Procedure in Patients With a Single Ventricle

IntroductionA Glenn shunt is a low mortality operation with an uncomplicated course in most patients; however some patients can have a complicated postoperative course with significantly increased morbidity and mortality.Hypotheses1. There are potentially modifiable risk factors for a complicated Gl...

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Veröffentlicht in:Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13961-A13961
Hauptverfasser: Khaira, Gurpreet, Sivarajan, Venkatesan B, Guerra, Gonzalo, Joffe, Ari, Robertson, Charlene M, Bond, Gwen Y
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container_end_page A13961
container_issue Suppl_1 Suppl 1
container_start_page A13961
container_title Circulation (New York, N.Y.)
container_volume 140
creator Khaira, Gurpreet
Sivarajan, Venkatesan B
Guerra, Gonzalo
Joffe, Ari
Robertson, Charlene M
Bond, Gwen Y
description IntroductionA Glenn shunt is a low mortality operation with an uncomplicated course in most patients; however some patients can have a complicated postoperative course with significantly increased morbidity and mortality.Hypotheses1. There are potentially modifiable risk factors for a complicated Glenn (cGP, defined as someone who has died or needed heart transplant by two years of age, required extracorporeal life support (ECLS), required Glenn takedown, or needed prolonged postoperative ventilation). 2. Having a cGP predicts adverse neurodevelopmental and functional outcomes in survivors after the Glenn.MethodsA prospective Western Canadian inception-cohort of all consecutive patients having the Glenn procedure from January 2012 to December 2017. Echocardiographic, catheterization, and cardiac MRI variables were collected retrospectively. Survivors had standardized neurodevelopmental assessments at two years of age.ResultsA total of 169 patients underwent a Glenn during the study period. Twenty-seven patients (16%) met criteria for a cGPpostoperatively 8 required ECLS, 6 required Glenn takedown and 16 required prolonged ventilation (> 90 percentile; 7 days). By age 2 years, 10 patients died and 3 required transplantation. Significant predictors identified after univariate analysis (p-value
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There are potentially modifiable risk factors for a complicated Glenn (cGP, defined as someone who has died or needed heart transplant by two years of age, required extracorporeal life support (ECLS), required Glenn takedown, or needed prolonged postoperative ventilation). 2. Having a cGP predicts adverse neurodevelopmental and functional outcomes in survivors after the Glenn.MethodsA prospective Western Canadian inception-cohort of all consecutive patients having the Glenn procedure from January 2012 to December 2017. Echocardiographic, catheterization, and cardiac MRI variables were collected retrospectively. Survivors had standardized neurodevelopmental assessments at two years of age.ResultsA total of 169 patients underwent a Glenn during the study period. Twenty-seven patients (16%) met criteria for a cGPpostoperatively 8 required ECLS, 6 required Glenn takedown and 16 required prolonged ventilation (&gt; 90 percentile; 7 days). By age 2 years, 10 patients died and 3 required transplantation. Significant predictors identified after univariate analysis (p-value &lt;0.05) were ECLS use pre-Glenn, lower pre-operative body weight, length and body surface area; concomitant systemic atrioventricular valve repair or replacement or atrial septectomy, cardiopulmonary bypass time, need for a second bypass run intra-operatively, need for intubation less than 24hrs from extubation, lactate peak on bypass, and first lactate off bypass. Having a cGP was a predictor of lower Bayley III testing for cognition (p=0.048), language (p=0.034), and motor skills (p=0.015).ConclusionDespite a Glenn overall having low mortality, patients with a cGP occurred in 16% of cases. Low body weight and factors that increase pulmonary venous pressure may predict a cGP. Procedures that can reduce pulmonary venous pressure (e.g. an atrial septectomy) may need to be an interstage procedure to reduce the risk of a cGP. Pre-operative Hemodynamic data analysis is pending.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circ.140.suppl_1.13961</identifier><language>eng</language><publisher>by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><ispartof>Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13961-A13961</ispartof><rights>2019 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Khaira, Gurpreet</creatorcontrib><creatorcontrib>Sivarajan, Venkatesan B</creatorcontrib><creatorcontrib>Guerra, Gonzalo</creatorcontrib><creatorcontrib>Joffe, Ari</creatorcontrib><creatorcontrib>Robertson, Charlene M</creatorcontrib><creatorcontrib>Bond, Gwen Y</creatorcontrib><title>Abstract 13961: Risk Factors for Adverse Outcomes After a Glenn Procedure in Patients With a Single Ventricle</title><title>Circulation (New York, N.Y.)</title><description>IntroductionA Glenn shunt is a low mortality operation with an uncomplicated course in most patients; however some patients can have a complicated postoperative course with significantly increased morbidity and mortality.Hypotheses1. There are potentially modifiable risk factors for a complicated Glenn (cGP, defined as someone who has died or needed heart transplant by two years of age, required extracorporeal life support (ECLS), required Glenn takedown, or needed prolonged postoperative ventilation). 2. Having a cGP predicts adverse neurodevelopmental and functional outcomes in survivors after the Glenn.MethodsA prospective Western Canadian inception-cohort of all consecutive patients having the Glenn procedure from January 2012 to December 2017. Echocardiographic, catheterization, and cardiac MRI variables were collected retrospectively. Survivors had standardized neurodevelopmental assessments at two years of age.ResultsA total of 169 patients underwent a Glenn during the study period. Twenty-seven patients (16%) met criteria for a cGPpostoperatively 8 required ECLS, 6 required Glenn takedown and 16 required prolonged ventilation (&gt; 90 percentile; 7 days). By age 2 years, 10 patients died and 3 required transplantation. Significant predictors identified after univariate analysis (p-value &lt;0.05) were ECLS use pre-Glenn, lower pre-operative body weight, length and body surface area; concomitant systemic atrioventricular valve repair or replacement or atrial septectomy, cardiopulmonary bypass time, need for a second bypass run intra-operatively, need for intubation less than 24hrs from extubation, lactate peak on bypass, and first lactate off bypass. Having a cGP was a predictor of lower Bayley III testing for cognition (p=0.048), language (p=0.034), and motor skills (p=0.015).ConclusionDespite a Glenn overall having low mortality, patients with a cGP occurred in 16% of cases. Low body weight and factors that increase pulmonary venous pressure may predict a cGP. Procedures that can reduce pulmonary venous pressure (e.g. an atrial septectomy) may need to be an interstage procedure to reduce the risk of a cGP. Pre-operative Hemodynamic data analysis is pending.</description><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqdTttKxDAUDKJgvfyCnB9IzUl6ob4VcfVN0WV9LDV7auNm2yUndX_fIH6BD8Mww8wwQtygyhErvLUu2BwLlfNyOPgOczRNhSciw1IXsihNcyoypVQja6P1ubhg_kqyMnWZiX37wTH0NsJv6w5eHe9glYw5MAxzgHb7TYEJnpdo5z0xtEOkAD08epomeAmzpe0SCFwSfXQ0RYZ3F8cUeXPTpyfYJC846-lKnA29Z7r-40tRrB7W90_yOPs0yju_HCl0I_U-jl06qYzCWmqFDWKCVFobNP-s_QAD0Fi_</recordid><startdate>20191119</startdate><enddate>20191119</enddate><creator>Khaira, Gurpreet</creator><creator>Sivarajan, Venkatesan B</creator><creator>Guerra, Gonzalo</creator><creator>Joffe, Ari</creator><creator>Robertson, Charlene M</creator><creator>Bond, Gwen Y</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope/></search><sort><creationdate>20191119</creationdate><title>Abstract 13961: Risk Factors for Adverse Outcomes After a Glenn Procedure in Patients With a Single Ventricle</title><author>Khaira, Gurpreet ; Sivarajan, Venkatesan B ; Guerra, Gonzalo ; Joffe, Ari ; Robertson, Charlene M ; Bond, Gwen Y</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-wolterskluwer_health_00003017-201911191-022313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Khaira, Gurpreet</creatorcontrib><creatorcontrib>Sivarajan, Venkatesan B</creatorcontrib><creatorcontrib>Guerra, Gonzalo</creatorcontrib><creatorcontrib>Joffe, Ari</creatorcontrib><creatorcontrib>Robertson, Charlene M</creatorcontrib><creatorcontrib>Bond, Gwen Y</creatorcontrib><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khaira, Gurpreet</au><au>Sivarajan, Venkatesan B</au><au>Guerra, Gonzalo</au><au>Joffe, Ari</au><au>Robertson, Charlene M</au><au>Bond, Gwen Y</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Abstract 13961: Risk Factors for Adverse Outcomes After a Glenn Procedure in Patients With a Single Ventricle</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><date>2019-11-19</date><risdate>2019</risdate><volume>140</volume><issue>Suppl_1 Suppl 1</issue><spage>A13961</spage><epage>A13961</epage><pages>A13961-A13961</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>IntroductionA Glenn shunt is a low mortality operation with an uncomplicated course in most patients; however some patients can have a complicated postoperative course with significantly increased morbidity and mortality.Hypotheses1. There are potentially modifiable risk factors for a complicated Glenn (cGP, defined as someone who has died or needed heart transplant by two years of age, required extracorporeal life support (ECLS), required Glenn takedown, or needed prolonged postoperative ventilation). 2. Having a cGP predicts adverse neurodevelopmental and functional outcomes in survivors after the Glenn.MethodsA prospective Western Canadian inception-cohort of all consecutive patients having the Glenn procedure from January 2012 to December 2017. Echocardiographic, catheterization, and cardiac MRI variables were collected retrospectively. Survivors had standardized neurodevelopmental assessments at two years of age.ResultsA total of 169 patients underwent a Glenn during the study period. Twenty-seven patients (16%) met criteria for a cGPpostoperatively 8 required ECLS, 6 required Glenn takedown and 16 required prolonged ventilation (&gt; 90 percentile; 7 days). By age 2 years, 10 patients died and 3 required transplantation. Significant predictors identified after univariate analysis (p-value &lt;0.05) were ECLS use pre-Glenn, lower pre-operative body weight, length and body surface area; concomitant systemic atrioventricular valve repair or replacement or atrial septectomy, cardiopulmonary bypass time, need for a second bypass run intra-operatively, need for intubation less than 24hrs from extubation, lactate peak on bypass, and first lactate off bypass. Having a cGP was a predictor of lower Bayley III testing for cognition (p=0.048), language (p=0.034), and motor skills (p=0.015).ConclusionDespite a Glenn overall having low mortality, patients with a cGP occurred in 16% of cases. Low body weight and factors that increase pulmonary venous pressure may predict a cGP. Procedures that can reduce pulmonary venous pressure (e.g. an atrial septectomy) may need to be an interstage procedure to reduce the risk of a cGP. Pre-operative Hemodynamic data analysis is pending.</abstract><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><doi>10.1161/circ.140.suppl_1.13961</doi></addata></record>
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title Abstract 13961: Risk Factors for Adverse Outcomes After a Glenn Procedure in Patients With a Single Ventricle
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