Author + information
- Carlos M. Mery,
- Martin A. Chacon-Portillo,
- Huirong Zhu,
- Heather Dickerson,
- Iki Adachi,
- Jeffrey Heinle,
- Lauren Kane,
- Emmett McKenzie and
- Charles Fraser
Background: There are limited studies analyzing pulsatile Glenns (PG) as a palliation strategy for complex single ventricle (SV) patients. This study sought to determine their outcomes at a single institution.
Methods: All SV pts who underwent PG from 1995-2016 were included. Failure was defined as takedown, transplant or death. Further palliation (FP) was defined as Fontan, 1.5 or biventricular repair. Risk factors were assessed by Cox multivariable competing risk analyses.
Results: 78 pts underwent PG at age 8.8 mos (86 days – 14 yrs). 28% had heterotaxy, 19% had genetic syndrome, 23% had abnormal inferior vena cava. There were 3 operative mortalities (4%). FP was performed in 40 pts (51%), 3 were 1.5 and one was biventricular repair [time-to-palliation 4 yrs (2-10)]. PG failure occurred in 9 pts (12%) with 7 total mortalities. 5- and 10-year overall survival was 90% and 86%. At median follow-up 6 yrs (1 mo-13 yrs), 29 pts (37%) remained with PG (age 7 yrs [7 mos-18 yrs], oxygen saturation 84% [74-90]). Preop moderate or severe atrioventricular valve regurgitation (AVVR) was predictor of PG failure (HR 6.1, 1.4-27.5). Reaching FP was less likely with AVVR (HR 0.2, 0.1-0.7) and heterotaxy or genetic syndrome (HR 0.5, 0.27-0.94).
Conclusions: Complex SV pts palliated with PG have a favorable long-term prognosis without reducing their suitability for FP, while delaying the consequences of a Fontan circulation. In some pts, PG is a suitable alternative to Fontan palliation, allowing some to reach adolescence.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1182-011
- 2017 American College of Cardiology Foundation