Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand

© 2020, The Japanese Association for Thoracic Surgery. Objectives: Owing to the evolution of surgical techniques, the survival rate of patients undergoing a bidirectional Glenn shunt has improved. However, the morbidity and mortality are still high. The aims of this study were to determine the survi...

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Main Authors: Saviga Sethasathien, Suchaya Silvilairat, Chayaporn Lhodamrongrat, Rekwan Sittiwangkul, Krit Makonkawkeyoon, Yupada Pongprot, Thirasak Borisuthipandit, Surin Woragidpoonpol
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Published: 2020
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/70897
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spelling th-cmuir.6653943832-708972020-10-14T08:44:24Z Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand Saviga Sethasathien Suchaya Silvilairat Chayaporn Lhodamrongrat Rekwan Sittiwangkul Krit Makonkawkeyoon Yupada Pongprot Thirasak Borisuthipandit Surin Woragidpoonpol Medicine © 2020, The Japanese Association for Thoracic Surgery. Objectives: Owing to the evolution of surgical techniques, the survival rate of patients undergoing a bidirectional Glenn shunt has improved. However, the morbidity and mortality are still high. The aims of this study were to determine the survival rate and risk factors influencing the morbidity and mortality in patients with a functional univentricular heart after a bidirectional Glenn shunt. Methods: One hundred and fifty-one patients who had undergone a bidirectional Glenn operation were enrolled. Early worse outcomes were defined as postoperative death within 30 days and a hospital stay ≥ 30 days. Results: The median age was 7.1 years (range 0.3–26 years). The median age at the time of the Glenn operation was 2.2 years (range 0.2–15.9 years). The survival rates of patients at 1-, 5-, 10- and 15-year after the Glenn operation were 89%, 79%, 75%, and 72%, respectively. The predictors for the mortality were preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2 and atrioventricular valve regurgitation. In addition, the independent predictors of an early worse outcome included preoperative mean pulmonary artery pressure ≥ 17 mmHg and diaphragmatic paralysis. Conclusion: The presence of preoperative atrioventricular valve regurgitation, preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2, or diaphragmatic paralysis were found to be independent risk factors requiring the good patients’ selection for the Glenn operation and early aggressive management of the diaphragmatic paralysis for reducing morbidity to ensure successful candidature for Fontan completion. 2020-10-14T08:44:24Z 2020-10-14T08:44:24Z 2020-01-01 Journal 18636713 18636705 2-s2.0-85089300126 10.1007/s11748-020-01461-9 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85089300126&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/70897
institution Chiang Mai University
building Chiang Mai University Library
continent Asia
country Thailand
Thailand
content_provider Chiang Mai University Library
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Saviga Sethasathien
Suchaya Silvilairat
Chayaporn Lhodamrongrat
Rekwan Sittiwangkul
Krit Makonkawkeyoon
Yupada Pongprot
Thirasak Borisuthipandit
Surin Woragidpoonpol
Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
description © 2020, The Japanese Association for Thoracic Surgery. Objectives: Owing to the evolution of surgical techniques, the survival rate of patients undergoing a bidirectional Glenn shunt has improved. However, the morbidity and mortality are still high. The aims of this study were to determine the survival rate and risk factors influencing the morbidity and mortality in patients with a functional univentricular heart after a bidirectional Glenn shunt. Methods: One hundred and fifty-one patients who had undergone a bidirectional Glenn operation were enrolled. Early worse outcomes were defined as postoperative death within 30 days and a hospital stay ≥ 30 days. Results: The median age was 7.1 years (range 0.3–26 years). The median age at the time of the Glenn operation was 2.2 years (range 0.2–15.9 years). The survival rates of patients at 1-, 5-, 10- and 15-year after the Glenn operation were 89%, 79%, 75%, and 72%, respectively. The predictors for the mortality were preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2 and atrioventricular valve regurgitation. In addition, the independent predictors of an early worse outcome included preoperative mean pulmonary artery pressure ≥ 17 mmHg and diaphragmatic paralysis. Conclusion: The presence of preoperative atrioventricular valve regurgitation, preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2, or diaphragmatic paralysis were found to be independent risk factors requiring the good patients’ selection for the Glenn operation and early aggressive management of the diaphragmatic paralysis for reducing morbidity to ensure successful candidature for Fontan completion.
format Journal
author Saviga Sethasathien
Suchaya Silvilairat
Chayaporn Lhodamrongrat
Rekwan Sittiwangkul
Krit Makonkawkeyoon
Yupada Pongprot
Thirasak Borisuthipandit
Surin Woragidpoonpol
author_facet Saviga Sethasathien
Suchaya Silvilairat
Chayaporn Lhodamrongrat
Rekwan Sittiwangkul
Krit Makonkawkeyoon
Yupada Pongprot
Thirasak Borisuthipandit
Surin Woragidpoonpol
author_sort Saviga Sethasathien
title Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
title_short Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
title_full Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
title_fullStr Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
title_full_unstemmed Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand
title_sort risk factors for morbidity and mortality after a bidirectional glenn shunt in northern thailand
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85089300126&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/70897
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