Glenn procedure should be done as soon as possible and definitely before the mean Pulmonary artery pressure elevated

Abstract

Introduction : There are still conflicting results regarding the effect of basal pulmonary arterial pressure on the consequences of Glenn surgery and require further studies in this regard. Aim of the study : Our main goal was to assess this hypothesis that the use of Glenn surgical technique (Glenn shunt implantation) can lead to better prognosis in patients with a single ventricular heart who are candidate of Fontan surgery by preserving pulmonary artery pressure, while that high baseline pulmonary artery pressure is considered a risk factor for poor prognosis. Methods: This retrospective study was conducted on 81 consecutive patients with single ventricle heart defect who underwent isolated Glenn surgery and their files were complete in Shahid Rajaei Heart Center in Tehran from 1 January 2019 till 3 March 2020 Based on the pulmonary artery pressure assessed by angiography, patients were classified into two groups, group A patients whose pulmonary artery pressure equal to or less than 15 mmHg (n=41) and group B patients whose pulmonary artery pressure above 15 mmHg (n = 40) and information on the outcome after surgery was compared between the two groups. Results: The prevalence rate of ascites (3 pts. 7.4% versus 19 pts. 48.1%, p = 0.001) and pleural effusion (33.3% versus 85.2%, p = 0.001), the mean length of hospital stay (6.00 ± 2.37 days versus 9.48 ± 6.86 days, p = 0.16) and length of ICU stay (3.93 ± 1.07 days versus 5.30 ± 2.30 days, p = 0.008) all were longer in those patients with PAP >15 mmHg (group B). But there was no difference in the rate of cardiac arrhythmia between the groups (p = 0.192) in our study. Conclusion: High pulmonary artery pressure is associated with more postoperative complications and can be considered as a prognostic factor in patients undergoing Glenn surgery as in fact, high pulmonary pressure associated with postoperative ascites, pleural effusion, and long-term hospitalization.