Unexpected Cardiac Interventions Including Takedown after Glenn Surgery : A Society of Thoracic Surgeons - Congenital Heart Surgery Database (STS-CHSD) Analysis

N. Behm¹, R. Mehta¹, C. Yerebakan², S. Deshpande^3
1Children's National Hospital, Washington, District of Columbia ²Children’s National Medical Center, Washington, District of Columbia ³Children's National Medical Center, Washington, District of Columbia

Purpose: Glenn procedures carry low morbidity and mortality within stages of single ventricle palliation.1 However, some patients with Glenn failure need a stage reversal while others require unanticipated surgical interventions. Our understanding of perioperative factors and outcomes associated with such unexpected interventions is extremely limited, leading to the current study2,3.

Methods: We analyzed the STS CHSD database4 for all patients undergoing Glenn palliation between 01/2010 to 12/2019 and identified those who underwent unexpected cardiac surgery after Glenn. Appropriate statistical analysis was used to identify differences and assess outcomes.

Results: A total of 16913 patients underwent Glenn palliation (Group 1) with 1221 (7.2%, Group 2) requiring a subsequent unexpected surgical intervention. Group 2 were younger, smaller in height and weight, had lower birth weight and less likely to be of White race. There was no difference by gender, prematurity or ventricular morphology. Group 2 had longer bypass time, cross clamp time, lower \ saturation and higher lactate on arrival to CICU (all p< 0.001). There were significant differences in outcomes: Length of stay, Group 1 median 9 (6,20) days compared to Group 2 median 36 (16,90) (p < 0.001); 30 day mortality of 1.2% (195) for Group 1 vs 6.6% (80) for Group 2; readmission within 30 days of 14.8% (2103) for Group 1 vs 26.3% (246) for Group 2 and mortality at 365 days of 5.7% (669) for Group 1 vs 22.5% (219) for Group2. (Table 1) Lastly, the group of patients requiring Glenn takedown to a shunt (n=77) had an operative mortality of 16.9% (13). Regression analysis showed unexpected surgery (OR 3.7,p < 0.001), dominant right ventricle (OR 2.06, p< 0.001), longer bypass time (OR 1.71 , p=0.034), and younger age (OR1.32, p=0.037) were with mortality after Glenn.

Conclusion: Need for unexpected surgical intervention after Glenn is associated with almost five times higher morbidity and mortality and more commonly in younger, smaller patients, with right ventricular dominance and complex operative course. Appropriate patient selection, timing of surgery and further understanding the perioperative factors is critical in reducing this risk.

Identify the source of the funding for this research project: Department Faculty Development Fund