146. Delineating the Midterm Outcomes and Impacts of the Turbo Glenn
University of Pittsburgh
Pittsburgh, PA
United States - Contact Me
Dr. Laura Seese is an ACGME congenital cardiothoracic surgery fellow at the Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center (UPMC). She obtained her medical degree from the University of California. Dr. Seese completed her integrated (I-6) cardiothoracic surgery residency at the University of Pittsburgh Medical Center. During that time, she completed a fully funded 2-year research fellowship during which time she published numerous papers and book chapters related to pediatric and adult cardiac surgery. She also obtained a master’s degree in clinical research and statistics with a special emphasis on clinical trials from the University of Pittsburgh. Dr. Seese is also a recipient of the AATS Cardiothoracic Surgery Ethics Forum Scholarship and has a critical interest in the intersection between ethics and cardiac surgical practice.
Description
Methods: This is a retrospective analysis that selected single ventricle patients from 2004-2022 who had undergone a Norwood procedure and progressed to stage 2 palliation with SPCP. We compared isolated SCPC to SCPC followed by BTT shunt (turbo Glenn) in the early postoperative period. Primary outcomes were achievement of Fontan circulation and transplant-free survival. Secondary outcomes were the incidence of postoperative complications, timing of turbo Glenn, and length of hospital stay. Patients who underwent initial hybrid operations with comprehensive stage 2 palliation were excluded.
Results: 154 patients were included with 14 (9.1%) turbo Glenns and 140 (90.9%) standard SCPC. Cardiopulmonary bypass times were longer in patients (66.9 ± 32.6 vs 91.9 ± 45.9 minutes, p=0.04) who ultimately required a turbo Glenn and 100% of the turbo Glenns were unplanned reoperations. The median time to turbo Glenn following SCPC was 2 days [IQT 0.5, 3.8]. There were similar interstage durations, preoperative oxygen saturations (SpO2), inhaled oxygen requirements, pulmonary artery z-scores, and pulmonary to systemic ratios between the groups (all, p>0.05). However, postoperative SpO2 was substantially lower in the turbo Glenn group with higher inhaled nitric oxide requirements (all, p<0.05). There were higher rates of SCPC take-down in the turbo Glenn group (21.4% vs 5.0%, p=0.04). Yet, the incidence of all complications were similar (all, p>0.05). The rates of mortality, heart transplantation, and progression to Fontan circulation were also similar (all, p>0.05). However, hospital LOS was longer in the turbo Glenn group (10 [IQR 6, 19] vs 19.5 [14.5, 37] days, p=0.009.
Conclusion: When compared to patients who undergo isolated SCPC, a turbo Glenn, in patients who require additional pulmonary blood flow, is a viable option for early postoperative rescue with similar rates of progression to Fontan circulation, Glenn takedown, and transplant-free survival.
Authors
Laura Seese (1), Carlos Diaz Castrillon (2), Melita Viegas (3), mario castro-medina (3), Luciana Da Fonseca da Silva (4), Jose Da Silva (4), Victor Morell (2)
Institutions
(1) University of Pittsburgh Medical Center, Pittsburgh, PA, (2) Children's Hospital of Pittsburgh, Pittsburgh, PA, (3) N/A, Pittsburgh, PA, (4) UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA