Valved Sano shunt tends to improve immediate outcomes following Norwood operation compared to non-valved Sano shunt.
Presented During:
Saturday, May 6, 2023: 8:15AM - 8:30AM
Los Angeles Convention Center
Posted Room Name:
403B
Abstract No:
13
Submission Type:
Abstract Submission
Authors:
Halil Beqaj (1), David Kalfa (2), Nimrod Goldshtrom (3), Matan Setton (4), Michael DiLorenzo (4), Andrew Goldstone (2), Oliver Barry (4), Amee Shah (4), Ganga Krishnamurthy (4), Emile Bacha (2)
Institutions:
(1) College of Physicians and Surgeons, Columbia University, New York, NY, (2) Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp., New York, NY, (3) Division of Neonatology, New York Presbyterian, Columbia University Medical Center, New York, NY, (4) Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
Submitting Author:
Halil Beqaj
-
Contact Me
College of Physicians and Surgeons, Columbia University
College of Physicians and Surgeons, Columbia University
Co-Author(s):
*David Kalfa
-
Contact Me
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Nimrod Goldshtrom
-
Contact Me
Division of Neonatology, New York Presbyterian, Columbia University Medical Center
Division of Neonatology, New York Presbyterian, Columbia University Medical Center
Matan Setton
-
Contact Me
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Michael DiLorenzo
-
Contact Me
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Andrew Goldstone
-
Contact Me
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Oliver Barry
-
Contact Me
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Amee Shah
-
Contact Me
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Ganga Krishnamurthy
-
Contact Me
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
Division of Pediatric Cardiology, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hospital
*Emile Bacha
-
Contact Me
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Pediatric and Congenital Cardiac Surgery, CUIMC/NewYork-Presbyterian Morgan Stanley Children's Hosp.
Presenting Author:
*David Kalfa
-
Contact Me
NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital
Abstract:
Objective: The use of a valved Sano at the time of stage I palliation has been reported previously, but its impact on clinical outcomes needs to be further elucidated. We assessed the impact of the valved Sano compared to the non-valved Sano following stage I palliation in HLHS patients.
Methods: We retrospectively reviewed 25 consecutive HLHS neonates who underwent a valved Sano (VS) stage I operation using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a standard non-valved Sano (NVS) between 2014 and 2022. Primary outcomes were ventricular function, tricuspid regurgitation, end-organ function, Sano and pulmonary artery (PA) reintervention, and survival at post-operative, discharge, interstage, and pre-Glenn time points.
Results: Perioperative characteristics and outcomes are summarized in Figure 1A. VS had a significantly lower peak lactate level (p=0.049), lactate 24 hours after peaking (p=0.02), time to diuresis (p=0.04), time to enteral feeds (p=0.02), and time to extubation (trend, p=0.08). No significant differences in mortality were seen during the hospital stay and interstage period (Fig 1A-C). The VS group had fewer patients requiring ECMO, experiencing cardiac arrest, and undergoing Sano and PA reinterventions prior to discharge following the Norwood operation (Fig 1A&B). The VS group trended towards fewer PA reinterventions overall (1 vs 7; p=0.116). Despite having worse ventricular function at baseline, the VS group showed significant improvement from the immediate post-operative period to discharge (Fig 1D arrow; p< 0.001). From preoperative to pre-Glenn time points, ventricular function within the VS was sustained, whereas ventricular function in the NVS group was significantly reduced by the time of pre-Glenn (Fig 1D; P<0.002). Pre-Glenn echocardiograms showed competent conduit valves in majority of the VS patients (n=16; 64%).
Conclusions: The VS is, or tends to be, associated with 1) improved multi-organ recovery and stability postoperatively, as demonstrated by lower lactate levels, time to diuresis, time to enteral feeds, and time to extubation; 2) increased hemodynamic stability, as exhibited by fewer patients needing ECMO or experiencing cardiac arrest postoperatively; 3) fewer PA reinterventions until stage II; and 4) augmented ventricular function recovery during stage I hospital stay. Assessment of mid- and long-term outcomes is warranted to evaluate the impact of valved Sano after stages II and III.
Methods: We retrospectively reviewed 25 consecutive HLHS neonates who underwent a valved Sano (VS) stage I operation using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a standard non-valved Sano (NVS) between 2014 and 2022. Primary outcomes were ventricular function, tricuspid regurgitation, end-organ function, Sano and pulmonary artery (PA) reintervention, and survival at post-operative, discharge, interstage, and pre-Glenn time points.
Results: Perioperative characteristics and outcomes are summarized in Figure 1A. VS had a significantly lower peak lactate level (p=0.049), lactate 24 hours after peaking (p=0.02), time to diuresis (p=0.04), time to enteral feeds (p=0.02), and time to extubation (trend, p=0.08). No significant differences in mortality were seen during the hospital stay and interstage period (Fig 1A-C). The VS group had fewer patients requiring ECMO, experiencing cardiac arrest, and undergoing Sano and PA reinterventions prior to discharge following the Norwood operation (Fig 1A&B). The VS group trended towards fewer PA reinterventions overall (1 vs 7; p=0.116). Despite having worse ventricular function at baseline, the VS group showed significant improvement from the immediate post-operative period to discharge (Fig 1D arrow; p< 0.001). From preoperative to pre-Glenn time points, ventricular function within the VS was sustained, whereas ventricular function in the NVS group was significantly reduced by the time of pre-Glenn (Fig 1D; P<0.002). Pre-Glenn echocardiograms showed competent conduit valves in majority of the VS patients (n=16; 64%).
Conclusions: The VS is, or tends to be, associated with 1) improved multi-organ recovery and stability postoperatively, as demonstrated by lower lactate levels, time to diuresis, time to enteral feeds, and time to extubation; 2) increased hemodynamic stability, as exhibited by fewer patients needing ECMO or experiencing cardiac arrest postoperatively; 3) fewer PA reinterventions until stage II; and 4) augmented ventricular function recovery during stage I hospital stay. Assessment of mid- and long-term outcomes is warranted to evaluate the impact of valved Sano after stages II and III.
CONGENTIAL:
Single Ventricle Management
Image or Table
