Bidirectional Glenn. Is accessory pulmonary blood flow good or bad?
Bidirectional Glenn. Is accessory pulmonary blood flow good or bad?
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DOI：
10.1161/01.cir.92.9.294
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发表时间：
1995-11
期刊：
影响因子：
37.8
通讯作者：
R. Mainwaring;J. J. Lamberti-J.;Karen Uzark;Robert L. Spicer
中科院分区：
文献类型：
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作者：
R. Mainwaring;J. J. Lamberti-J.;Karen Uzark;Robert L. Spicer
背景双向 Glenn (BDG) 经常用于单心室患者的分期手术治疗。是否应在 BDG 时保留辅助肺血流 (APBF) 源以增加全身饱和度，还是应消除其以减少心室的容量负荷，仍存在争议。本研究是一项回顾性研究，旨在评估 APBF 对 BDG 后结果的影响。方法和结果 1986 年至 1994 年间，有 92 名患者在我们研究所接受了 BDG。在 BDG 时，有 40 名患者进行了全身至肺动脉分流或右心室流出道开放作为肺血流的额外来源。 52 名患者已消除 APBF。共有 3 例手术死亡（2 例有 APBF，1 例没有 APBF），4 例手术失败（每组 2 例），需要随后进行修复。至此，共有85名患者接受了成功的手术。 85 名患者中有 8 名出现积液（定义为胸管引流持续时间超过 7 天）； 36 名患有 APBF 的患者中有 7 名 (19%) 出现了这种并发症，而 49 名无 APBF 的患者中则有 1 名 (2%) (P < .05)。共有 11 例死亡，其中 6 名患者（17%）患有 APBF，2 名患者（4%）无 APBF，以及 3 名患者（75%）BDG 失败。结论 数据表明，在 BDG 时消除 APBF 的患者发病率和死亡率较低。
BACKGROUND The bidirectional Glenn (BDG) is frequently used in the staged surgical management of single ventricle patients. Controversy exists whether accessory pulmonary blood flow (APBF) sources should be left at the time of the BDG to augment systemic saturation or should be eliminated to reduce volume load of the ventricle. The present study was a retrospective review to assess the influence of APBF on outcome after the BDG. METHODS AND RESULTS Ninety-two patients have undergone BDG at our institute during the interval from 1986 through 1994. At the time of BDG, 40 patients had either a systemic-to-pulmonary artery shunt or patent right ventricular outflow tract as an additional source of pulmonary blood flow. Fifty-two patients had elimination of APBF. There were three operative deaths (two with and one without APBF) and four procedures (two in each group) that failed and required subsequent revision. Thus, there were 85 patients who underwent successful operation. Effusions (defined as chest tube drainage exceeding 7 days' duration) occurred in 8 of 85 patients; this complication was seen in 7 of 36 patients (19%) with APBF and 1 of 49 patients (2%) without APBF (P < .05). There were 11 deaths, including 6 patients (17%) with APBF, 2 patients (4%) without APBF, and 3 of the patients (75%) who had a failed BDG. CONCLUSIONS The data suggest that morbidity and mortality are lower in patients in whom APBF is eliminated at the time of the BDG.