Risk factors of mortality and insufficiency of cavopulmonary hemodynamics in patients after bidirectional Glen procedure

Abstract

Objective. The study was to focus on the evaluation of in-hospital mortality, survival and risk factors of adverse outcomes in patients after bidirectional Glen procedure (BGP).Methods. Clinical data of 130 patients who underwent BGP over a period from 2003 to 2013 were analyzed retrospectively. Patients’ age at the time of the procedure was 16 months (lower/upper quartiles 9/27 months).Results. In-hospital mortality after BGP was 10.7%. According to the results of multivariable logistic regression analysis, the patients age, degree of atrioventricular valve (AVV) regurgitation (OR 0.79; 95% CI 0.62-0.99; р = 0.05) and duration of cardiopulmonary bypass (CPB) (OR 1.33; 95% CI 1.03-1.72; р = 0.03) were the predictors of in-hospital mortality. The 1-, 3- and 10-year survival of patients after BGP was 86.3%, 85.1% and 83.4% respectively. Freedom from adverse outcomes (mortality, removal of cavopulmonary anastomosis, unsuitable candidate for Fontan procedure) was 83.3% and 76.3% at 1- and 5-year follow-up respectively. Multivariable analysis of adverse outcome risks revealed that an increase of blood pressure in BGP (HR 1.11; 95% CI 1.00-1.22; p = 0.04), low saturation (HR 0.90; 95% CI 0.84-0.97; р<0.01) and thrombosis (HR 4.55; 95% CI 1.89-10.9; р<0.01) increased the risk of mortality and insufficiency of cavopulmonary hemodynamics in the post-operative period.Conclusion. Younger age, high-grade AVV regurgitation and prolonged CPB increase the risk of in-hospital mortality. Low saturation, elevation of blood pressure and cavopulmonary shunt thrombosis in the post-operative period tend to be the main predictors of survival after BGP and impossibility of conversion to Fontan circulation.

Keywords

• Единственный желудочек сердца
• Двунаправленный кавопульмональный анастомоз
• Факторы риска