Assistant Professor of Pediatrics Emory University School of Medicine, Children's Healthcare of Atlanta Atlanta, Georgia, United States
Abstract: Introduction/
Background: The impact of antegrade pulmonary blood flow (APBF) during single-ventricle (SV) palliation continues to be debated. Competing data demonstrates better pulmonary artery (PA) growth and saturations versus higher PA pressures and longer post-operative course. We sought to understand the impact of ABPF in a large cohort of patients undergoing SV palliation.
Methods: Retrospective single-center study at an academic quaternary children’s hospital. All SV patients with APBF were matched 1:2 with patients who did not have APBF, operated on between January/2008 and December/2020. Analysis was performed using appropriate statistics with significance level set at p=0.05.
Results: During the study period 553 patients reached stage 2 palliation, of which 76 (13.6%) had APBF. Sixty-nine patients with APBF were matched 1:2 with 138 patients with no-APBF (controls) by BSA at pre-superior cavo-pulmonary anastomosis (Stage 2) catheterization, and by surgical era (pre-2014, and 2014-2020). At the pre-Stage 2 catheterization, APBF patients had higher median SVC saturations (54.5% vs 50.0%), larger median left and right PA diameter size (0.6 vs 0.5 cm) and z-scores (p < 0.05). For Stage 2 surgery, the APBF cohort had greater median weight (6.5 vs 6.1 kg), shorter CPB time (51.0 vs 84.5 min), shorter hospital LOS (5.0 vs 7.0 days) and were more likely to have a left ventricle as the systemic ventricle (p < 0.05). The pre-Stage 3 catheterization variables were similar between APBF cases and the controls. The indexed pulmonary vascular resistance (PVRi) was slightly lower in the APBF cohort (1.7 vs 2.0 in controls) however, it did not reach statistical significance (p=0.20). SVC saturations (70%), hemoglobin (15g/dl) and arterial saturation (85%) were nearly identical at time of Stage 3 catheterization for the two groups.
Conclusions: In a large single center study, we saw that patients with SV physiology with APBF demonstrate larger PA size early during staged palliation and had better peri-operative course with shorter CPB time and shorter hospital stay after Stage 2 palliation. At Stage 3, there was no difference in pre- or post-operative outcomes. Leaving antegrade flow did not worsen the PVRi at Stage 3 and may be better but needs further investigation. We intend to study the short as well as long term outcomes of these two cohorts.
