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Pre-Glenn aorto-pulmonary collaterals in single-ventricle patients

Published online by Cambridge University Press:  17 April 2023

Varun J. Sharma Open the ORCID record for Varun J. Sharma [Opens in a new window] ,
Laura Carlson Open the ORCID record for Laura Carlson [Opens in a new window] ,
Jesse Esch Open the ORCID record for Jesse Esch [Opens in a new window] ,
Mallika Gopal ,
Kimberlee Gauvreau ,
Isaac Wamala ,
Angelika Muter ,
Diego Porras  and
Meena Nathan Open the ORCID record for Meena Nathan [Opens in a new window]
Varun J. Sharma*
Affiliation:
Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
Laura Carlson
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
Jesse Esch
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Mallika Gopal
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
Kimberlee Gauvreau
Affiliation:
Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
Isaac Wamala
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
Angelika Muter
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA
Diego Porras
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA Department of Pediatrics, Harvard Medical School, Boston, MA, USA
Meena Nathan
Affiliation:
Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA Department of Surgery, Harvard Medical School, Boston, MA, USA
*
Author for correspondence: Dr V. J. Sharma, Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA, USA. E-mail: sharma.varun.j@gmail.com
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Abstract

Background:

In single-ventricle patients undergoing staged-bidirectional Glenn, 36–59% have aorto-pulmonary collateral flow, but risk factors and clinical outcomes are unknown. We hypothesise that shunt type and catheter haemodynamics may predict pre-bidirectional Glenn aorto-pulmonary collateral burden, which may predict death/transplantation, pulmonary artery or aorto-pulmonary collateral intervention.

Methods:

Retrospective cohort study of patients undergoing a Norwood procedure for single-ventricle anatomy. Covariates included clinical and haemodynamic characteristics up to/including pre-bidirectional Glenn catheterisation and aorto-pulmonary collateral burden at pre-bidirectional Glenn catheterisation. Multivariable models used to evaluate relationships between risk factors and outcomes.

Results:

From January 2011 to March 2016, 104 patients underwent Norwood intervention. Male sex (odds ratio 3.36, 95% confidence interval 1.17–11.4), age at pre-bidirectional Glenn assessment (2.12, 1.33–3.39 per month), and pulmonary to systemic flow ratio (1.23, 1.08–1.41 per 0.1 unit) were associated with aorto-pulmonary collateral burden. Aorto-pulmonary collateral burden was not associated with death/transplantation (hazard ratio 1.19, 95% confidence interval 0.37–3.85), pulmonary artery (sub-hazard ratio 1.38, 0.32–2.61), or aorto-pulmonary collateral interventions (sub-hazard ratio 1.11, 0.21–5.76). Longer post-Norwood length of stay was associated with greater risk of death/transplantation (hazard ratio 1.22 per week, 95% confidence interval 1.08–1.38), but lower risk of aorto-pulmonary collateral intervention (sub-hazard ratio 0.86 per week, 95% confidence interval 0.75–0.98). Time to pre-bidirectional Glenn catheterisation was associated with lower risk of pulmonary artery (sub-hazard ratio 0.80 per month, 95% confidence interval 0.65–0.98) and aorto-pulmonary collateral intervention (sub-hazard ratio 0.79, 0.63–0.99). Probability of moderate/severe aorto-pulmonary collateral burden increased with left-to-right shunt (22.5% at <1.0, 57.6% at >1.4) and the age at pre-bidirectional Glenn catheterisation (10.6% at <2 months, 56.9% at >5 months).

Conclusions:

Aorto-pulmonary collateral burden is common after Norwood procedure and increases as age at bidirectional Glenn increases. As expected, higher pulmonary to systemic flow ratio is a marker for greater aorto-pulmonary collateral burden pre-bi-directional Glenn; aorto-pulmonary collateral burden does not confer risk of death/transplantation or pulmonary artery intervention.

Keywords

Aorto-pulmonary collateralsNorwood procedurebidirectional Glennhypoplastic left heart syndrome
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 12 , December 2023 , pp. 2589 - 2596
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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