Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective
Objective: To identify risk factors for aortopulmonary collateral (APC) development and assess the impact of severe APCs in children undergoing staged single ventricle palliation. Methods: Children undergoing a bidirectional Glenn operation between January 1, 2016, and March 31, 2021, at our center...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | JTCVS Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623002802 |
| _version_ | 1797385020918202368 |
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| author | Clifford W. Chin, MD George T. Nicholson, MD David P. Bichell, MD |
| author_facet | Clifford W. Chin, MD George T. Nicholson, MD David P. Bichell, MD |
| author_sort | Clifford W. Chin, MD |
| collection | DOAJ |
| description | Objective: To identify risk factors for aortopulmonary collateral (APC) development and assess the impact of severe APCs in children undergoing staged single ventricle palliation. Methods: Children undergoing a bidirectional Glenn operation between January 1, 2016, and March 31, 2021, at our center were included. All underwent angiography prior to Glenn and Fontan; APC flow was graded on a scale of 0 (no appreciable collateral flow) to 4 (severe burden). Demographic data, congenital diagnosis, clinical history, and outcomes were stratified by Glenn assessment; Fontan outcomes were stratified by pre-Fontan grade. Results: Sixty patients met the inclusion criteria, all of whom had angiographic evidence of APCs. There were 7 transplants and 9 deaths in the cohort. There were no significant differences in demographics among the patients. Right ventricular morphology was more common in patients with severe pre-Glenn collaterals (24 of 44 vs 2 of 6 vs 7 of 8; P = .014). Longer stage 1 aortic cross-clamp duration was associated with greater severity pre-Glenn (44 minutes vs 34 minutes vs 66 minutes; P = .023). Patients with grade 3 pre-Glenn collaterals more commonly required transplantation than those with grade 1 collaterals (P < .001) and had lower overall transplant-free survival than those with grade 1 (P = .005) or grade 2 (P = .04) collaterals. Conclusions: The ubiquity of APCs in this study demonstrates their prevalence in single ventricle disease. Right ventricular morphology and prolonged aortic cross-clamp duration are associated with higher burden. Greater severity was associated with decreased transplant-free survival. These data emphasize the negative long-term impact of these collaterals. |
| first_indexed | 2024-03-08T21:48:05Z |
| format | Article |
| id | doaj.art-6e6c54c9c53c4f5cadbae29ccef645b6 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-08T21:48:05Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-6e6c54c9c53c4f5cadbae29ccef645b62023-12-20T07:38:14ZengElsevierJTCVS Open2666-27362023-12-0116844854Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspectiveClifford W. Chin, MD0George T. Nicholson, MD1David P. Bichell, MD2Vanderbilt University School of Medicine, Nashville, Tenn; Address for reprints: Clifford W. Chin, MD, 303 Light Hall, 2215 Garland Ave, Nashville, TN 37232-9292.Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carrell Jr Children's Hospital, Nashville, TennDivision of Pediatric Cardiac Surgery, Department of Pediatrics, Monroe Carrell Jr Children's Hospital, Nashville, TennObjective: To identify risk factors for aortopulmonary collateral (APC) development and assess the impact of severe APCs in children undergoing staged single ventricle palliation. Methods: Children undergoing a bidirectional Glenn operation between January 1, 2016, and March 31, 2021, at our center were included. All underwent angiography prior to Glenn and Fontan; APC flow was graded on a scale of 0 (no appreciable collateral flow) to 4 (severe burden). Demographic data, congenital diagnosis, clinical history, and outcomes were stratified by Glenn assessment; Fontan outcomes were stratified by pre-Fontan grade. Results: Sixty patients met the inclusion criteria, all of whom had angiographic evidence of APCs. There were 7 transplants and 9 deaths in the cohort. There were no significant differences in demographics among the patients. Right ventricular morphology was more common in patients with severe pre-Glenn collaterals (24 of 44 vs 2 of 6 vs 7 of 8; P = .014). Longer stage 1 aortic cross-clamp duration was associated with greater severity pre-Glenn (44 minutes vs 34 minutes vs 66 minutes; P = .023). Patients with grade 3 pre-Glenn collaterals more commonly required transplantation than those with grade 1 collaterals (P < .001) and had lower overall transplant-free survival than those with grade 1 (P = .005) or grade 2 (P = .04) collaterals. Conclusions: The ubiquity of APCs in this study demonstrates their prevalence in single ventricle disease. Right ventricular morphology and prolonged aortic cross-clamp duration are associated with higher burden. Greater severity was associated with decreased transplant-free survival. These data emphasize the negative long-term impact of these collaterals.http://www.sciencedirect.com/science/article/pii/S2666273623002802congenital cardiacsingle ventricleheart transplantation |
| spellingShingle | Clifford W. Chin, MD George T. Nicholson, MD David P. Bichell, MD Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective JTCVS Open congenital cardiac single ventricle heart transplantation |
| title | Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective |
| title_full | Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective |
| title_fullStr | Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective |
| title_full_unstemmed | Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective |
| title_short | Severe aortopulmonary collaterals are associated with lower transplant-free survival in patients undergoing staged single ventricle palliationCentral MessagePerspective |
| title_sort | severe aortopulmonary collaterals are associated with lower transplant free survival in patients undergoing staged single ventricle palliationcentral messageperspective |
| topic | congenital cardiac single ventricle heart transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623002802 |
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