Evaluating Clinical Outcomes of the Bidirectional Glenn and Fontan Procedures in Pediatric Patients with Hypoplastic Left Heart Syndrome
Introduction: We evaluated the clinical outcomes on pediatric Hypoplastic Left Heart Syndrome (HLHS) patients that underwent both the Bidirectional Glenn (BDG) and Fontan procedures at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Methods: We conducted a retrospective study whereby pediatric patients with HLHS that underwent stage II and stage III palliative surgeries (BDG and Fontan). Patient health information was collected from Epic electronic medical record system. Data was analyzed in determining any correlation between BDG and Fontan complications, and to indicate if negative consequences of the BDG procedure predicted an increased risk of poor outcomes of the Fontan procedure. Statistical analysis was conducted using SAS 9.4 and significance was set a priori at p <0.05. Results: The cohort contained 102 patients under the age of 17, between the years 2000-2018. The Pearson Correlation statistical test identified that there was no statistical significance between the BDG and Fontan complications (p=0.96). However, backward logistic regression reported post-operative oxygen saturation after the BDG operation, posed an increased risk of poor outcomes of the Fontan operation (p=0.01). In addition, we conducted a subset analysis, to determine if any demographic factors played a role in poor outcomes or complications of the Fontan operation and if there were any Fontan covariates that impact Fontan complications. The measurements we examined were significant: insurance (p=0.01), pre-operative oxygen saturation (p=0.02) , interval between BDG and Fontan (p=0.00), post-operative oxygen saturation (p=0.01), post-operative transfusion of blood products (p=0.01), and ICU stay for 6 or more days (p=0.00). Conclusions: The data in this study suggests that Fontan complications are not largely impacted by BDG variables. Clinically, this is great news because although patients may experience detrimental conditions related to the BDG, that does not suggest that they will experience immediate Fontan complications. However, long term Fontan outcome studies will be needed to access the full clinical effect of complications in HLHS.
Jayla Alexandria Moore,
"Evaluating Clinical Outcomes of the Bidirectional Glenn and Fontan Procedures in Pediatric Patients with Hypoplastic Left Heart Syndrome"
ETD Collection for Tennessee State University.