The Annals of thoracic surgery · 2020
Results of Less Than 5-mm Right Ventricle-Pulmonary Artery Conduits in Single Ventricle Palliation.
СтатьяНазвание и аннотация: Перевод в очереди
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Sinha Raina, Chen Peter, Sam Rebecca, Dodge-Khatami Ali, Salazar Jorge D
Аннотация
BACKGROUND: Our programmatic approach to single ventricle (SV) neonatal palliation has evolved to using smaller-size right ventricle to pulmonary artery (RV-PA) conduits for pulmonary blood flow. Therefore, we sought to compare the early outcomes of less than 5-mm versus 5-mm RV-PA conduits in SV patients undergoing neonatal palliation.
METHODS: We performed a retrospective review of SV patients who had neonatal palliation with either a less than 5-mm or 5-mm RV-PA connection, constructed using a waterproof, breathable fabric membrane graft (Gore-Tex, Flagstaff, AZ). Data before, during, and after surgery were analyzed using SPSS software.
RESULTS: A total of 26 patients in group 1 (n = 11; <5 mm) and group 2 (n = 15; 5 mm) were operated on, with a mean follow-up of 13 months. Statistical differences (P ≤ .05) were noted with renal near-infrared spectroscopy (mean, 56 versus 44), and oxygen saturation at discharge (mean, 80% versus 85%) in groups 1 and 2, respectively. We found no significant difference in patient weight, peak lactate, cerebral near-infrared spectroscopy, length of intubation, length of hospitalization, or need for RV-PA conduit intervention after stage 1 along with age, branch PA sizes, or need for PA plasty at bidirectional Glenn between groups.
CONCLUSIONS: Our early results of less than 5-mm conduits support further exploration into the tailoring of the RV-PA conduit size for each patient. A smaller-diameter conduit may improve systemic cardiac output and net oxygen delivery. Larger patient cohorts and longer follow-up with assessment of pulmonary artery growth are warranted to guide clinical practice.
METHODS: We performed a retrospective review of SV patients who had neonatal palliation with either a less than 5-mm or 5-mm RV-PA connection, constructed using a waterproof, breathable fabric membrane graft (Gore-Tex, Flagstaff, AZ). Data before, during, and after surgery were analyzed using SPSS software.
RESULTS: A total of 26 patients in group 1 (n = 11; <5 mm) and group 2 (n = 15; 5 mm) were operated on, with a mean follow-up of 13 months. Statistical differences (P ≤ .05) were noted with renal near-infrared spectroscopy (mean, 56 versus 44), and oxygen saturation at discharge (mean, 80% versus 85%) in groups 1 and 2, respectively. We found no significant difference in patient weight, peak lactate, cerebral near-infrared spectroscopy, length of intubation, length of hospitalization, or need for RV-PA conduit intervention after stage 1 along with age, branch PA sizes, or need for PA plasty at bidirectional Glenn between groups.
CONCLUSIONS: Our early results of less than 5-mm conduits support further exploration into the tailoring of the RV-PA conduit size for each patient. A smaller-diameter conduit may improve systemic cardiac output and net oxygen delivery. Larger patient cohorts and longer follow-up with assessment of pulmonary artery growth are warranted to guide clinical practice.