Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

TANG Shang-qiu; LI Yi-fan; ZHANG Zhi-wei

摘要：Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease (CHD) who are not suitable for biventricular repair in early life.There is limited evidence of successful strategies for long-term hemodynamic stabilization.Furthermore,there have been no data on optimal hemodynamics that could be used as a reference for patients' follow-on management.Methods Sixty CHD patients,44 male and 16 female,with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016.Pre-and post Glenn shunt percutaneous oxygen saturation (SpO2),6-minute walk test (6MWT),superior vena cava pressure (SVCP),pulmonary arterial pressure (PAP),pulmonary capillary wedge pressure (PCWP),pulmonary vascular resistance (PVR),small pulmonary vascular resistance (sPVR) were measured.Pre-and post-total cavopulmonary connection (TCPC) SpO2,and in-hospital complications were monitored.The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic (ROC) curve analysis.Results SpO2 was significantly increased by bidirectional Glenn shunt surgery (75.42 ± 9.62％ to 86.98 ± 7.63％,P ＜ 0.001) from 82.70 ± 5.99％ to 95.00 ±4.07％ in the 47 patients with TCPC.Forty-two patients completed the 6MWT with a mean distance of 362.7 ±75.0 m and a SpO2 decrease from 81.80 ± 7.84％ to 67.59 ± 1.82％ (P ＜ 0.001).The △ SpO2 and 6-minute walk distance(6MWD) in the 32 who underwent TCPC and ten of them did not reach statistical significance (17.22 ±13.82％ vs.13.87 ± 8.74％,P =0.08 and 358.88 ± 78.97 m vs.374.80 ± 62.55 m,P =0.564].After cardiac catheterization,47 patients were selected for TCPC.The fight pulmonary artery systolic pressure (sRPAP),mean fight pulmonary artery pressure (mRPAP),mean left pulmonary artery pressure (mLPAP),PVR,and sPVR were significantly lower in the TCPC group than in the non-TCPC group.The differences in superior vena cava systolic blood pressure (sSVCP),mean superior vena cava pressure (mSVCP),and left pulmonary artery systolic pressure (sLPAP) were not significant.The optimal cutoff values for TCPC were sSVCP ≤ 20 mmHg (P =0.025),sRPAP ≤ 22 mmHg (P =0.0001,mRPAP ≤ 13 mmHg (P =0.003),sLPAP ≤27 mmHg (P =0.03),mLPAP ≤11mmHg (P =0.01),PVR ≤ 4.3 Wood U/m2 (P ＜0.0001) and were significantly associated with TCPC selection,except for mSVCP ≤ 19 mmHg (P =0.06) and sPVR ≤ 2.0 wood U/m2 (P =0.0531).One patient died because of low cardiac output after TCPC.In-hospital mortality was 2.1％.Conclusion The SpO2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery.The 6MWT is an index of activity tolerance prior to TCPC.Hemodynamic values of sSVCP ≤ 20 mmHg,sRPAP ≤ 22 mmHg,mRPAP ≤ 13 mmHg,sLPAP ≤ 27 mmHg,mLPAP ≤ 11 mmHg,and PVR ≤ 4.3 Wood U/m2 can help identify post Glenn-shunt patients indicated for TCPC.