@Article{chd.12664,
AUTHOR = {Martin A. Chacon‐Portillo, Rodrigo Zea‐Vera, Huirong Zhu, Heather A. Dickerson, Iki Adachi, Jeffrey S. Heinle, Charles D. Fraser, Carlos M. Mery},
TITLE = {Pulsatile Glenn as long‐term palliation for single ventricle physiology patients},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {6},
PAGES = {927--934},
URL = {http://www.techscience.com/schd/v13n6/39076},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> There are limited studies analyzing pulsatile Glenn as a long‐term pallia‐
tion strategy for single ventricle patients. This study sought to determine their out‐
comes at a single institution.<br/>
<b>Design:</b> A retrospective review was performed.<br/>
<b>Setting:</b> Study performed at a single pediatric hospital.<br/>
<b>Patients:</b> All single ventricle patients who underwent pulsatile Glenn from 1995 to
2016 were included.<br/>
<b>Outcome measures:</b> Pulsatile Glenn failure was defined as takedown, transplant, or
death. Further palliation was defined as Fontan, 1.5, or biventricular repair. Risk fac‐
tors were assessed by Cox multivariable competing risk analyses.<br/>
<b>Results:</b> Seventy‐eight patients underwent pulsatile Glenn at age 9 months (inter‐
quartile range, 5‐14). In total, 28% had heterotaxy, 18% had a genetic syndrome, and
24% had an abnormal inferior vena cava. There were 3 (4%) perioperative mortalities.
Further palliation was performed in 41 (53%) patients with a median time‐to‐pallia‐
tion of 4 years (interquartile range, 3‐5). Pulsatile Glenn failure occurred in 10 (13%)
patients with 8 total mortalities. Five‐ and 10‐year transplant‐free survival were 91%
and 84%, respectively. At a median follow‐up of 6 years (interquartile range, 2‐8), 27
patients (35%) remained with PG (age 7 years [interquartile range, 3‐11], oxygen sat‐
uration 83% ± 4%). Preoperative moderate‐severe atrioventricular valve regurgita‐
tion (AVVR) (hazard ratio 7.77; 95% confidence interval 1.80‐33.43; P =.005) and
higher pulmonary vascular resistance (hazard ratio 2.59; 95% confidence interval
1.08‐6.15; P =.031) were predictors of pulsatile Glenn failure after adjusting for co‐
variates. Reaching further palliation was less likely in patients with preoperative
moderate‐severe AVVR (hazard ratio 0.22, 95% confidence interval 0.08‐0.59;
P =.002).<br/>
<b>Conclusion:</b> Pulsatile Glenn can be an effective tool to be used in challenging circum‐
stances, these patients can have a favorable long‐term prognosis without reducing
their suitability for further palliation.},
DOI = {10.1111/chd.12664}
}